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
State | License ID | Taxonomies |
---|---|---|
MI | 4301116166 | 208600000X |
390200000X | ||
NC | 2016-01109 | 2086S0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086S0102X | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |