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General NPI Number Information
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NPI Number | 1477549061
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Entity Type | Individual
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Provider Name | MAIDA P. ANTIGUA M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 11/13/2023
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Provider Practice Location Address
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Address Line | 160 OLD DERBY ST STE 451
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City | HINGHAM
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State | MA
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Zip | 02043-4062
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Country | US
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Telephone | 781-980-1290
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Fax | 781-374-7207
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Provider Business Mailing Address
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Address Line | 160 OLD DERBY ST STE 451
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City | HINGHAM
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State | MA
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Zip | 02043-4062
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Country | US
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Telephone | 781-980-1290
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Fax | 781-374-7207
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 40534
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License Number State | MA
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