Healthcare Provider Details

I. General information

NPI: 1801810866
Provider Name (Legal Business Name): MARK J KANTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR STE 110
HAMPTON VA
23666-5906
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-8486
  • Fax: 757-827-8718
Mailing address:
  • Phone: 757-232-8769
  • Fax: 757-232-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101041391
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: