Provider Demographics
NPI:1922703693
Name:MAIDA P ANTIGUA
Entity Type:Organization
Organization Name:MAIDA P ANTIGUA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAIDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANTIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-980-1290
Mailing Address - Street 1:160 OLD DERBY ST STE 451
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4062
Mailing Address - Country:US
Mailing Address - Phone:781-980-1290
Mailing Address - Fax:
Practice Address - Street 1:160 OLD DERBY ST STE 451
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4062
Practice Address - Country:US
Practice Address - Phone:781-980-1290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty