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General NPI Number Information
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NPI Number | 1710998836
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Entity Type | Individual
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Provider Name | DIVYA B CANTOR MD
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 2215 PORTLAND AVE
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City | LOUISVILLE
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State | KY
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Zip | 40212-1033
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Country | US
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Telephone | 502-774-8631
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Fax | 502-772-8189
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Provider Business Mailing Address
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Address Line | 2215 PORTLAND AVE
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City | LOUISVILLE
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State | KY
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Zip | 40212-1033
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Country | US
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Telephone | 502-774-8631
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Fax | 502-772-8189
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30033
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | G72946
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License Number State | CA
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