Healthcare Provider Details

I. General information

NPI: 1477046043
Provider Name (Legal Business Name): JONATHAN IOANITESCU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 07/23/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

3500 GASTON AVE BAYLOR UNIVERSITY MEDICAL CENTER, 6TH FLOOR ROBERTS
DALLAS TX
75246
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-0111
  • Fax:
Mailing address:
  • Phone: 214-820-9543
  • Fax: 214-820-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberV2501
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberV2501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: