MEDICARE: MR. THOMAS ALAN KANTOR PA-C

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	174400000X	Specialist	PA30213	DC

General Provider Information

NPI Number	:	1578653671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS ALAN KANTOR PA-C

Provider Business Mailing Address
First Line	:	110 QUAIL CREEK DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3435
Country	:	US
Telephone Number	:	803-530-5904
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 QUAIL CREEK DR
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-3435
Country	:	US
Telephone Number	:	803-530-5904
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	08/18/2008

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