Healthcare Provider Details

I. General information

NPI: 1124973995
Provider Name (Legal Business Name): RYAN MICHAEL ANTAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVENUE 301 BUILDING, ROOM 3112
BALTIMORE MD
21224
US

IV. Provider business mailing address

4940 EASTERN AVENUE 301 BUILDING, ROOM 3112
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0338
  • Fax: 410-550-3341
Mailing address:
  • Phone: 410-550-0338
  • Fax: 410-550-3341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: