Healthcare Provider Details

I. General information

NPI: 1164638953
Provider Name (Legal Business Name): KANTA ARYA MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR SUITE 3L
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR SUITE 3L
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-139-1815
  • Fax: 606-436-5021
Mailing address:
  • Phone: 606-139-1815
  • Fax: 606-436-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KANTA ARYA
Title or Position: PHYSICIAN
Credential: MD
Phone: 606-439-1815