Individual
JONATHAN HARRY DEANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 E BROAD ST, RICHMOND, VA 23219-1930
(804) 828-3500
(804) 628-4501
Mailing address
PO BOX 780125, PHILADELPHIA, PA 19178-0125
(804) 944-4844
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101279414
VA
208600000X
Surgery Physician
T5097
TX
2086S0102X
Surgical Critical Care Physician
0101279414
VA
2086S0120X
Pediatric Surgery Physician
0101279414
VA
2086S0120X
Pediatric Surgery Physician
T5097
TX
Other
Enumeration date
04/23/2014
Last updated
10/15/2023
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