Provider Demographics
NPI:1356538474
Name:JOSEPH D'ANTONIO JR., M.D., PHD, P.A.
Entity type:Organization
Organization Name:JOSEPH D'ANTONIO JR., M.D., PHD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANTONIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-879-3336
Mailing Address - Street 1:2205 YORK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3163
Mailing Address - Country:US
Mailing Address - Phone:410-296-3416
Mailing Address - Fax:410-296-1796
Practice Address - Street 1:2205 YORK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3163
Practice Address - Country:US
Practice Address - Phone:410-296-3416
Practice Address - Fax:410-296-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058991800Medicaid
MD025LMedicare PIN
MD058991800Medicaid