MEDICARE: DR. THOMAS JAMES CANTILINA MD

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
1	2083C0008X	Clinical Informatics Physician	MD070186L	PA
2	207Q00000X	Family Medicine Physician	MD070186L	PA

General Provider Information

NPI Number	:	1134111453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JAMES CANTILINA MD

Provider Business Mailing Address
First Line	:	307 BOATNER RD STE 114
Second Line	:
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1302
Country	:	US
Telephone Number	:	850-883-8555
Fax Number	:	850-883-9702

Provider Business Practice Location Address
First Line	:	9300 DEWITT LOOP
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5285
Country	:	US
Telephone Number	:	703-681-1774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/10/2023

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