Provider Demographics
NPI:1457419814
Name:ANTONOPOULOS, GEORGE V (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:V
Last Name:ANTONOPOULOS
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 1:1625 STRAITS TURNPIKE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-758-9100
Mailing Address - Fax:
Practice Address - Street 1:1625 STRAITS TURNPIKE
Practice Address - Street 2:SUITE 209
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-758-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042450207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001424506Medicaid
CT060001593Medicare ID - Type Unspecified
CTH46085Medicare UPIN