Provider Demographics
NPI:1750477147
Name:ANTOLIN, ROMEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMEL
Middle Name:C
Last Name:ANTOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 530
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:765-521-1217
Mailing Address - Fax:765-521-1218
Practice Address - Street 1:1000 N. 16TH ST.
Practice Address - Street 2:SUITE #250
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-521-1217
Practice Address - Fax:765-521-1218
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044040207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200060010Medicaid
ING11551Medicare UPIN
IN200060010Medicaid