Provider Demographics
NPI:1578653671
Name:KANTOR, THOMAS ALAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALAN
Last Name:KANTOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 QUAIL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3435
Mailing Address - Country:US
Mailing Address - Phone:803-530-5904
Mailing Address - Fax:
Practice Address - Street 1:110 QUAIL CREEK DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3435
Practice Address - Country:US
Practice Address - Phone:803-530-5904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA30213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54149Medicare UPIN