MEDICARE: DR. CHARLES MAURICE KANTROW JR. M.D.

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	207R00000X	Internal Medicine Physician	009101	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629028790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES MAURICE KANTROW JR. M.D.

Provider Business Mailing Address
First Line	:	9422 SCOTLAND AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-3951
Country	:	US
Telephone Number	:	225-774-1822
Fax Number	:	225-774-1836

Provider Business Practice Location Address
First Line	:	9422 SCOTLAND AVE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-3951
Country	:	US
Telephone Number	:	225-774-1822
Fax Number	:	225-774-1836

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/31/2007

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Directions to “ DR. CHARLES MAURICE KANTROW JR. M.D.” Practice Location

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