Provider Demographics
NPI:1912368788
Name:OCTAVIAN ANTOHI, MD PA
Entity Type:Organization
Organization Name:OCTAVIAN ANTOHI, MD PA
Other - Org Name:OCTAVIAN ANTOHI, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTOHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-345-1575
Mailing Address - Street 1:126 SILVER SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4357
Mailing Address - Country:US
Mailing Address - Phone:915-345-1575
Mailing Address - Fax:
Practice Address - Street 1:2630 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902
Practice Address - Country:US
Practice Address - Phone:915-345-1575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3147207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty