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General NPI Number Information
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NPI Number | 1548624372
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Entity Type | Organization
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Legal Business Name | MARK D ANTENUCCI DPM PC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD SUITE 7
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 575-624-2398
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Fax | 575-624-0655
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Provider Business Mailing Address
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Address Line | 313 W COUNTRY CLUB RD SUITE 7
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 575-624-2398
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Fax | 575-624-0655
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CRISTINA ANTENUCCI
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Credential |
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Telephone | 575-624-2398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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