MEDICARE: DONNA LYNN ANTONUCCI 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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	MD034035E	PA

General Provider Information

NPI Number	:	1871607382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LYNN ANTONUCCI M.D.

Provider Business Mailing Address
First Line	:	301 FLORAL VALE BLVD
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-5525
Country	:	US
Telephone Number	:	215-579-9933
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 FLORAL VALE BLVD
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-5525
Country	:	US
Telephone Number	:	215-579-9933
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/08/2007

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