Provider Demographics
NPI:1952768343
Name:ANTONESCU, IOANA (MD)
Entity Type:Individual
Prefix:DR
First Name:IOANA
Middle Name:
Last Name:ANTONESCU
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 1:3404 WAKE FOREST RD STE 202
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7341
Mailing Address - Country:US
Mailing Address - Phone:919-576-8155
Mailing Address - Fax:919-862-5483
Practice Address - Street 1:3404 WAKE FOREST RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7341
Practice Address - Country:US
Practice Address - Phone:919-576-8155
Practice Address - Fax:919-862-5483
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2021-10-26
Deactivation Date:2016-08-18
Deactivation Code:
Reactivation Date:2016-09-08
Provider Licenses
StateLicense IDTaxonomies
MI4301116166208600000X
390200000X
NC2016-011092086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program