Provider Demographics
NPI:1669612925
Name:KOSTAS, ANTIGONE D (MD)
Entity type:Individual
Prefix:
First Name:ANTIGONE
Middle Name:D
Last Name:KOSTAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOLLY HILL LN STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-2917
Mailing Address - Country:US
Mailing Address - Phone:203-622-1310
Mailing Address - Fax:203-622-1311
Practice Address - Street 1:75 HOLLY HILL LN STE 100
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-2917
Practice Address - Country:US
Practice Address - Phone:203-622-1310
Practice Address - Fax:203-622-1311
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0497462084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry