Basic Information
| Provider Information | |||||||||
| NPI: | 1811057391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTELMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13844 RUSSELL ZEPP DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210291442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1045315357 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 TWIN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107375744 | ||||||||
| FaxNumber: | 1017375745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101032110 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD039618 | DC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0024877 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.