Provider Demographics
NPI:1992783344
Name:ANTECOL, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:ANTECOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19436 HOWELL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-6459
Mailing Address - Country:US
Mailing Address - Phone:315-786-2000
Mailing Address - Fax:315-786-2899
Practice Address - Street 1:19436 HOWELL DR
Practice Address - Street 2:SUITE A
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-6459
Practice Address - Country:US
Practice Address - Phone:315-786-2000
Practice Address - Fax:315-786-2899
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2015-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2090561207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01658391Medicaid
NY01658391Medicaid