Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Oleg Antonov MD PC

Organization Dermatology Physician · NPI 1710307087

Oleg Antonov MD PC is a Dermatology Physician in Philadelphia, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2014.

Licensed in
PA
In the registry since
2014
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

11400 Bustleton Ave
Philadelphia, PA 19116-2815
Phone: (267) 639-0528
Fax: (215) 969-4451
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence MD432473 (PA)

Record details

NPI number1710307087
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Oleg Antonov — Owner · (267) 639-0528
NPI enumeratedApril 24, 2014
Last updated in NPPESApril 24, 2014
Mailing address11400 Bustleton Ave, Philadelphia, PA 19116-2815

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