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General NPI Number Information
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NPI Number | 1578653671
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Entity Type | Individual
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Provider Name | THOMAS ALAN KANTOR PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 110 QUAIL CREEK DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3435
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Country | US
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Telephone | 803-530-5904
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Fax |
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Provider Business Mailing Address
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Address Line | 110 QUAIL CREEK DR
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-3435
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Country | US
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Telephone | 803-530-5904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PA30213
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License Number State | DC
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