Provider Demographics
NPI:1295793693
Name:D'ANTONIO, MARY CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CHRISTINE
Last Name:D'ANTONIO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4720 S I 10 SERVICE RD W
Mailing Address - Street 2:SUITE 406
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-7404
Mailing Address - Country:US
Mailing Address - Phone:504-457-2020
Mailing Address - Fax:504-456-3113
Practice Address - Street 1:4720 S I 10 SERVICE RD W STE 406
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1242
Practice Address - Country:US
Practice Address - Phone:504-457-2020
Practice Address - Fax:504-456-3113
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2024-11-11
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Provider Licenses
StateLicense IDTaxonomies
LAMD.023344207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1496448Medicaid
LA1496448Medicaid