MEDICARE: ANTONIADES ORTHOPAEDICS, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
3	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	873AAN	OTHER	MD	BC / BS OF MD
2	J817	OTHER	MD	BLUECHOICE

General Provider Information

NPI Number	:	1710913934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTONIADES ORTHOPAEDICS, LLC

Provider Business Mailing Address
First Line	:	25 BARTHEL CT
Second Line	:
City	:	TIMONIUM
State	:	MD
Zip	:	21093-1528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3449 WILKENS AVE
Second Line	:	STE 107
City	:	BALTIMORE
State	:	MD
Zip	:	21229-5281
Country	:	US
Telephone Number	:	410-368-9992
Fax Number	:	410-368-9997

Authorized Official
Title or Position	:	MD
Name	:	JOHN ANTONIADES
Credential	:	MD
Telephone Number	:	410-951-1773

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	10/22/2012

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Directions to “ANTONIADES ORTHOPAEDICS, LLC ” Practice Location

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