Individual
DR. DAVID RICHARD ANTONIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
95 HARRIS RD, BUILDING 5, KILMARNOCK, VA 22482-3845
(804) 435-3146
(804) 435-6054
Mailing address
1115 BOULDERS PKWY, SUITE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101034363
VA
207X00000X
Orthopaedic Surgery Physician
Primary
0101034363
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011595
ANTHEM HEALTH PLANS OF VA
VA
05
—
1750374005
—
VA
01
—
200005729
RAILROAD MEDICARE
VA
05
—
64-12785
—
VA
01
—
P00717232
RR MEDICARE
VA
Enumeration date
08/23/2005
Last updated
02/05/2013
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