Provider Demographics
NPI:1568612331
Name:KANTOLA, MARK A (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:KANTOLA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 FRIENDSHIP AVE
Mailing Address - Street 2:SUITE
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1779
Mailing Address - Country:US
Mailing Address - Phone:412-235-5877
Mailing Address - Fax:412-235-5851
Practice Address - Street 1:4727 FRIENDSHIP AVE
Practice Address - Street 2:SUITE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1779
Practice Address - Country:US
Practice Address - Phone:412-235-5877
Practice Address - Fax:412-235-5851
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN573756367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12078239OtherCAQH
PA142827OtherMEDICARE PTAN