Organization
OLEG ANTONOV MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLEG ANTONOV M.D. (OWNER)
(267) 639-0528
Entity
Organization
Contact information
Practice address
11400 BUSTLETON AVE, PHILADELPHIA, PA 19116-2815
(267) 639-0528
(215) 969-4451
Mailing address
11400 BUSTLETON AVE, PHILADELPHIA, PA 19116-2815
(267) 639-0528
(215) 969-4451
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD432473
PA
Other
Enumeration date
04/24/2014
Last updated
04/24/2014
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