Provider Demographics
NPI:1154317089
Name:KANTAS, SPYRIDON (MD)
Entity Type:Individual
Prefix:DR
First Name:SPYRIDON
Middle Name:
Last Name:KANTAS
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 1:63 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-409-1137
Mailing Address - Fax:978-409-1906
Practice Address - Street 1:63 PARK STREET
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-409-1137
Practice Address - Fax:978-409-1906
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216696207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2084520Medicaid
MAH07415-Medicare UPIN
MAA37634Medicare PIN