Healthcare Provider Details

I. General information

NPI: 1871607382
Provider Name (Legal Business Name): DONNA LYNN ANTONUCCI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FLORAL VALE BLVD
YARDLEY PA
19067-5525
US

IV. Provider business mailing address

301 FLORAL VALE BLVD
YARDLEY PA
19067-5525
US

V. Phone/Fax

Practice location:
  • Phone: 215-579-9933
  • Fax:
Mailing address:
  • Phone: 215-579-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberMD034035E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: