Provider Demographics
NPI:1104833656
Name:KANTOR, SETH M (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:M
Last Name:KANTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 385
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-947-3700
Mailing Address - Fax:614-947-3771
Practice Address - Street 1:3900 STONERIDGE LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-2009
Practice Address - Country:US
Practice Address - Phone:614-798-7905
Practice Address - Fax:614-798-7952
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35048989207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0521439Medicaid
OH0521439Medicaid
OHKA0871654Medicare ID - Type Unspecified