Healthcare Provider Details

I. General information

NPI: 1518951508
Provider Name (Legal Business Name): RAYMOND J ANTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E RIVER DR #300 C/O IPMS
EAST HARTFORD CT
06108-3288
US

IV. Provider business mailing address

99 E RIVER DR #300 C/O IPMS
EAST HARTFORD CT
06108-3288
US

V. Phone/Fax

Practice location:
  • Phone: 860-282-4133
  • Fax: 860-289-0742
Mailing address:
  • Phone: 860-282-4133
  • Fax: 860-289-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number015864
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: