MEDICARE: RICHARD ANGELO 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
1	207RH0003X	Hematology & Oncology Physician	MD0000017010	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4082085	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841290541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ANGELO ANTONUCCI MD

Provider Business Mailing Address
First Line	:	726 HAMPTON ROADS DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-4071
Country	:	US
Telephone Number	:	865-675-1209
Fax Number	:	865-675-1109

Provider Business Practice Location Address
First Line	:	7551 DANNAHER WAY
Second Line	:
City	:	POWELL
State	:	TN
Zip	:	37849-4029
Country	:	US
Telephone Number	:	865-637-9330
Fax Number	:	865-859-7222

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/13/2015

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