Healthcare Provider Details

I. General information

NPI: 1285849117
Provider Name (Legal Business Name): ROBERT ANTONIUK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/05/2021
Certification Date: 06/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

2101 E JEFFERSON ST SUITE 4E
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-6625
  • Fax:
Mailing address:
  • Phone: 301-816-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD039151
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number244820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: