Organization
OLEG ANTONOV MD PC
Active
Other names
11400 Bustleton Avenue
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLEG ANTONOV MD (OWNER)
(215) 111-1111
Entity
Organization
Contact information
Practice address
11400 BUSTLETON AVE, PHILADELPHIA, PA 19116
(215) 111-1111
Mailing address
11400 BUSTLETON AVE, PHILADELPHIA, PA 19116-2815
(215) 111-1111
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
07/09/2013
Last updated
07/09/2013
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