Mark D Antenucci DPM PC

Primary specialty

PodiatristTaxonomy code 213E00000X

Legal business name

MARK D ANTENUCCI DPM PC

Practice address

313 W Country Club Rd
Suite 7
Roswell, NM 88201-5804

Phone

(575) 624-2398

Fax

(575) 624-0655

NPI assigned

Apr 7, 2016

Last updated

Apr 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Cristina Antenucci

Title

Office Manager

Phone

(575) 624-2398

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark David Antenucci, D.P.M

  • Podiatrist
  • Roswell, NM
  • NPI 1760490759
  Medicare reassignment NPD

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459987200000",
    "number": "1548624372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 W COUNTRY CLUB RD",
            "address_2": "SUITE 7",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015804",
            "telephone_number": "575-624-2398",
            "fax_number": "575-624-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 W COUNTRY CLUB RD",
            "address_2": "SUITE 7",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882015804",
            "telephone_number": "575-624-2398",
            "fax_number": "575-624-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK D ANTENUCCI DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-07",
        "last_updated": "2016-04-07",
        "status": "A",
        "authorized_official_last_name": "ANTENUCCI",
        "authorized_official_first_name": "CRISTINA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "575-624-2398",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55657",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guyla J Maples
• James Javier Marcilla, PHARM.D., PH.C, RPH
• Lisa Elizabeth Marcilla, PHARMD
• Mark a Carey DDS PC
• Mark Andrews MD LLC
• Mark D. Murley PC
• Jelena Markovic, M.D
• Michael Paul Marquardt, M.D.
• David Ellis Martin, RPH
• Mireya Martinez Mata

• Podiatrist in Roswell, NM
• Providers in Roswell, NM by specialty
• Podiatrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.