=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033206826
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IONUT ANTON M.D. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 02/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 GRANDVIEW AVE SUITE 204
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-596-1906
-----------------------------------------------------
Fax | 203-596-1861
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 GRANDVIEW AVE SUITE 204
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708-2517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-596-1906
-----------------------------------------------------
Fax | 203-596-1861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DOCTOR
-----------------------------------------------------
Name | DR. IONUT B ANTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 203-596-1909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 040407
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------