MEDICARE: DR. DAVID RICHARD ANTONIO M.D.

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	174400000X	Specialist	0101034363	VA
2	207X00000X	Orthopaedic Surgery Physician	0101034363	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	200005729	OTHER	VA	RAILROAD MEDICARE
5	P00717232	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011595	OTHER	VA	ANTHEM HEALTH PLANS OF VA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750374005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RICHARD ANTONIO M.D.

Provider Business Mailing Address
First Line	:	1115 BOULDERS PKWY
Second Line	:	SUITE 200
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-560-5595
Fax Number	:	804-560-9029

Provider Business Practice Location Address
First Line	:	95 HARRIS RD
Second Line	:	BUILDING 5
City	:	KILMARNOCK
State	:	VA
Zip	:	22482-3845
Country	:	US
Telephone Number	:	804-435-3146
Fax Number	:	804-435-6054

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	02/05/2013

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