Provider Demographics
NPI:1265535512
Name:ANTONIADES, SPIRO B (MD)
Entity type:Individual
Prefix:
First Name:SPIRO
Middle Name:B
Last Name:ANTONIADES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S TOLLGATE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6010
Mailing Address - Country:US
Mailing Address - Phone:410-877-7776
Mailing Address - Fax:443-402-1221
Practice Address - Street 1:2014 S TOLLGATE RD STE 107
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6010
Practice Address - Country:US
Practice Address - Phone:410-446-8747
Practice Address - Fax:443-643-2088
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047688207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF 482 / 001OtherBLUE CHOICE
MD032500700Medicaid
MDLZ51/546417-06, 07,OtherBS / BC OF MD
MDLZ51/546417-08, 09OtherBC /BS OF MD
MDF 482 / 001OtherBLUE CHOICE
MD032500700Medicaid