Individual
MICHAEL J ANTONIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
149 NORTH ST, EMERGENCY DEPARTMENT, WATERVILLE, ME 04901-4974
(207) 872-1303
(207) 872-1302
Mailing address
149 NORTH ST, WATERVILLE, ME 04901-4974
(207) 872-1303
(207) 872-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
016913
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
154420000
—
ME
Enumeration date
08/03/2006
Last updated
04/12/2011
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