Healthcare Provider Details

I. General information

NPI: 1215927900
Provider Name (Legal Business Name): MEGHAL R ANTANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 NATIONAL HARBOR BLVD STE 104
OXON HILL MD
20745-1052
US

IV. Provider business mailing address

4255 ALTAMONT PL STE 101
WHITE PLAINS MD
20695-3066
US

V. Phone/Fax

Practice location:
  • Phone: 866-800-2346
  • Fax:
Mailing address:
  • Phone: 866-800-2346
  • Fax: 206-984-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101234204
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101234204
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0060278
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: