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NPI Code Detail

MEDICARE: ERIC BRUCE ANTONUCCI MD

MEDICARE: ERIC BRUCE ANTONUCCI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician35.148423OH

General Provider Information

NPI Number : 1053818336
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC BRUCE ANTONUCCI MD
Provider Business Mailing Address
First Line : 2945 MAPLE AVE
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-1762
Country : US
Telephone Number : 740-454-0158
Fax Number :
Provider Business Practice Location Address
First Line : 2945 MAPLE AVE
Second Line :
City : ZANESVILLE
State : OH
Zip : 43701-1762
Country : US
Telephone Number : 740-454-0158
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2018
Last Update Date : 09/05/2023

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