MEDICARE: DR. JONATHAN KANTOR 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	207N00000X	Dermatology Physician	ME 92201	FL
2	207N00000X	Dermatology Physician	MD424017	PA

General Provider Information

NPI Number	:	1326038886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN KANTOR MD

Provider Business Mailing Address
First Line	:	3624 MARKET ST
Second Line	:	560W
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0000
Country	:	US
Telephone Number	:	215-662-2737
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0000
Country	:	US
Telephone Number	:	215-662-2737
Fax Number	:

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

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	08/29/2012

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