MEDICARE: MS. MARLA A KANTARAS 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	208000000X	Pediatrics Physician	350738555	OH

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	:	1710971965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLA A KANTARAS M.D.

Provider Business Mailing Address
First Line	:	4575 EVERHARD RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2406
Country	:	US
Telephone Number	:	330-494-5600
Fax Number	:	330-966-1644

Provider Business Practice Location Address
First Line	:	4575 EVERHARD RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2406
Country	:	US
Telephone Number	:	330-494-5600
Fax Number	:	330-966-1644

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	01/19/2012

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