Provider Demographics
NPI:1770550238
Name:ANTON, IONUT B (MD)
Entity type:Individual
Prefix:DR
First Name:IONUT
Middle Name:B
Last Name:ANTON
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 1:171 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2517
Mailing Address - Country:US
Mailing Address - Phone:203-596-1909
Mailing Address - Fax:203-596-1861
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-596-1909
Practice Address - Fax:203-596-1861
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040407207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001404079Medicaid
CT010040407CT01OtherANTHEM BC/BS
CT061587189OtherONE HEALTH PLAN
CT2V2344OtherHEALTHNET
CT3086658001OtherCIGNA
CT3076886OtherAETNA
CT061587189OtherUNITED HEALTHCARE
CT040407OtherCONNECTICARE
CT110246861OtherRAILROAD MEDICARE
CT061587189OtherUNITED HEALTHCARE
CT110008703Medicare ID - Type Unspecified