Provider Demographics
NPI:1285128348
Name:ANTONELLI, RAY GALLAGHER (MD)
Entity type:Individual
Prefix:MR
First Name:RAY
Middle Name:GALLAGHER
Last Name:ANTONELLI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5440
Mailing Address - Fax:252-536-5444
Practice Address - Street 1:108 N MOSBY AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NC
Practice Address - Zip Code:27850-9804
Practice Address - Country:US
Practice Address - Phone:252-586-5411
Practice Address - Fax:252-586-2028
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2021-02280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine