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NPI Code Detail

MEDICARE: MR. THOMAS J. GANTNER PAC

MEDICARE: MR. THOMAS J. GANTNER PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50-003782OH
2363AS0400XSurgical Physician Assistant50.003782OH

General Provider Information

NPI Number : 1003242298
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS J. GANTNER PAC
Provider Business Mailing Address
First Line : 2750 NEWARK GRANVILLE RD
Second Line :
City : GRANVILLE
State : OH
Zip : 43023-9142
Country : US
Telephone Number : 740-788-9220
Fax Number : 740-522-8070
Provider Business Practice Location Address
First Line : 2750 NEWARK GRANVILLE RD
Second Line :
City : GRANVILLE
State : OH
Zip : 43023-9142
Country : US
Telephone Number : 740-788-9220
Fax Number : 740-522-8070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2013
Last Update Date : 11/11/2021

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Directions to “ MR. THOMAS J. GANTNER PAC” Practice Location

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