MEDICARE: ELENA CAMELIA ANTONESCU D.O.

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
1	2085R0202X	Diagnostic Radiology Physician	58.002534	OH
2	2085R0204X	Vascular & Interventional Radiology Physician	58.002534	OH
3	2085B0100X	Body Imaging Physician	58.002534	OH
4	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	58.002534	OH
5	2085U0001X	Diagnostic Ultrasound Physician	58.002534	OH
6	2085N0700X	Neuroradiology Physician	58.002534	OH
7	2085N0904X	Nuclear Radiology Physician	58.002534	OH
8	2085P0229X	Pediatric Radiology Physician	58.002534	OH
9	2085R0001X	Radiation Oncology Physician	58.002534	OH
10	2085R0205X	Radiological Physics Physician	58.002534	OH
11	2085R0203X	Therapeutic Radiology Physician	58.002534	OH
12	207U00000X	Nuclear Medicine Physician	58.002534	OH

General Provider Information

NPI Number	:	1497936421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA CAMELIA ANTONESCU D.O.

Provider Business Mailing Address
First Line	:	23068 MARION RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-1137
Country	:	US
Telephone Number	:	440-263-8221
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 OLD CLINIC BUILDING CLB
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27599-0001
Country	:	US
Telephone Number	:	919-966-4292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	11/22/2013

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