Individual
DR. DEMETRI ANTONIOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,D.M.D.
Contact information
Practice address
15 SEWALL ST, PORTLAND, ME 04102-2641
(207) 774-1775
(207) 774-3126
Mailing address
15 SEWALL ST, PORTLAND, ME 04102-2641
(207) 774-1775
(207) 774-3126
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
012240
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
048010
ANTHEM
ME
05
—
118090000
—
ME
Enumeration date
09/30/2006
Last updated
07/08/2007
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