Individual provider Active NPI

Cosmin Gheorghe Antonescu

  • Mental Health Counselor
  • Gaithersburg, MD
National Provider Identifier
1124639133
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
10595 Issued in MD
Practice address
208 Fountain Green LN
Gaithersburg, MD 20878-7853
Phone
(301) 300-4353
NPI assigned
Aug 12, 2020
Last updated
Aug 12, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 10595 MD Primary

Addresses

Primary practice location

208 Fountain Green LN
Gaithersburg, MD 20878-7853

Mailing address

208 Fountain Green LN
Gaithersburg, MD 20878-7853
Phone (301) 300-4353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240111001432 DC Practitioner - Mental Health Counselor 2860843166 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Vesta, Inc.Group PAC ID 3678568375, 20 clinicians

Practice addresses (Care Compare)

20410 Observation Dr
Suite 108
Germantown, MD 20876-6419
Phone (240) 296-5858

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10595MDMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Vesta Inc CurrentSince Jan 1, 2024 Accepting new patients
Vesta, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

3900 Forestville Rd
Forestville, MD 20747
Phone (240) 296-5848

20410 Observation Dr
Ste 108
Germantown, MD 20876
Phone (240) 296-5862

9301 Annapolis Rd
Ste 300
Lanham, MD 20706
Phone (240) 296-5848

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597190400000",
    "number": "1124639133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 FOUNTAIN GREEN LN",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208787853",
            "telephone_number": "301-300-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 FOUNTAIN GREEN LN",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208787853",
            "telephone_number": "301-300-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANTONESCU",
        "first_name": "COSMIN",
        "middle_name": "GHEORGHE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-12",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "10595",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaithersburg, MD

Sources for this page

Verify at the official NPI Registry.