Provider Demographics
NPI:1679773667
Name:ROBERT C. CANTU MD NEUROLOGICAL SURGERY, INC.
Entity Type:Organization
Organization Name:ROBERT C. CANTU MD NEUROLOGICAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-369-1386
Mailing Address - Street 1:131 ORNAC
Mailing Address - Street 2:JOHN CUMING BUILDING SUITE 820
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4181
Mailing Address - Country:US
Mailing Address - Phone:978-369-1386
Mailing Address - Fax:978-287-0047
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:JOHN CUMING BUILDING SUITE 820
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-369-1386
Practice Address - Fax:978-287-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28386174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M01876OtherBLUE CROSS
M10876OtherMEDICARE TYPE UNSPECIFIED
MAB73441Medicare UPIN