Provider Demographics
NPI:1154368405
Name:CONSTANTINE, RADU (MD)
Entity type:Individual
Prefix:
First Name:RADU
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RADU
Other - Middle Name:
Other - Last Name:CONSTANTINESCU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:126 HOSPITAL AVENUE
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36361-0864
Mailing Address - Country:US
Mailing Address - Phone:334-774-2224
Mailing Address - Fax:
Practice Address - Street 1:2126 W ROY PARKER RD STE 203
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-8566
Practice Address - Country:US
Practice Address - Phone:845-481-8258
Practice Address - Fax:334-443-0179
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07804800208600000X
MI4301085335208600000X
NY260389208600000X
ALMD.32802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I020975Medicare UPIN
102465UP4Medicare ID - Type Unspecified