Healthcare Provider Details

I. General information

NPI: 1457419814
Provider Name (Legal Business Name): GEORGE V ANTONOPOULOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TURNPIKE SUITE 209
MIDDLEBURY CT
06762
US

IV. Provider business mailing address

1625 STRAITS TURNPIKE SUITE 209
MIDDLEBURY CT
06762
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-9100
  • Fax:
Mailing address:
  • Phone: 203-758-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number042450
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: