Basic Information
| Provider Information | |||||||||
| NPI: | 1427016443 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTOSZYK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | NICHOLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7048388494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 04/23/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0107X | 28615 | NC | N | 207W00000X | 28615 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 6871 | 01 | NC | PARTNERS | OTHER | 0841446 | 01 | NC | UNITED HEALTHCARE | OTHER | 20095440 | 01 | SC | SELECT HEALTH OF SC | OTHER | 4324369 | 01 | NC | AETNA | OTHER | 10481 | 01 | NC | KANAWHA | OTHER | 141002 | 01 | NC | COVENTRY | OTHER | 1922 | 01 | NC | DOCTORS HEALTH PLAN | OTHER | 51704 | 01 | NC | MEDCOST | OTHER | 772907 | 01 | SC | WELLCARE | OTHER | 8911627 | 05 | NC | MEDICAID | 100703 | 01 | NC | WELLNESS | OTHER | N28615 | 05 | SC | MEDICAID | 0382669002 | 01 | NC | CIGNA | OTHER | 10590 | 01 | NC | WELLPATH | OTHER | 276584 | 01 | NC | MAMSI | OTHER | 10413 | 01 | NC | BCBS/MEDPOINT | OTHER | 11627 | 01 | NC | BCBS | OTHER | 6301533 | 05 | VA | MEDICAID |