Healthcare Provider Details

I. General information

NPI: 1720152655
Provider Name (Legal Business Name): JOSHUA DAVID KANTROWITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 SHERMAN DR NVRH ST. JOHNSBURY PEDIATRICS
ST JOHNSBURY VT
05819-9280
US

IV. Provider business mailing address

97 SHERMAN DR NVRH ST. JOHNSBURY PEDIATRICS
ST JOHNSBURY VT
05819-9280
US

V. Phone/Fax

Practice location:
  • Phone: 802-748-5131
  • Fax: 802-748-4237
Mailing address:
  • Phone: 802-748-5131
  • Fax: 802-748-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0011638
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: