Basic Information
| Provider Information | |||||||||
| NPI: | 1275576928 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANTOSIA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 HOPE ST | ||||||||
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| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062026 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | BETH ISREAL DEACONESS MEDICAL CENTER | ||||||||
| Address2: | W/CC 2, ONE DEACONESS ROAD | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022155321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176677000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 75742 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.