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Contact Information

MARK D ANTENUCCI DPM PC
313 W COUNTRY CLUB RD
SUITE 7
ROSWELL, NM88201-5804
 Phone: 575-624-2398
 Fax: 575-624-0655
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for MARK D ANTENUCCI DPM PC · (Female)

NPI Number 1548624372
Status Active
Credentials
Entity Individual
Enumeration date 04/07/2016
Last updated 04/07/2016 - About 10 years ago
Sole proprietor 1 Not specified
Identifiers
  • NM Medicaid 55657
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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