Healthcare Provider Details

I. General information

NPI: 1073664181
Provider Name (Legal Business Name): DENIS ANTOINE II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 NATHAN SHOCK DRIVE
BALTIMORE MD
21224
US

IV. Provider business mailing address

PO BOX 23834
BALTIMORE MD
21203-5834
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-2796
  • Fax: 410-550-0030
Mailing address:
  • Phone: 410-550-2796
  • Fax: 410-550-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0070585
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: