Provider Demographics
NPI:1710998836
Name:CANTOR, DIVYA B (MD)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:B
Last Name:CANTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:ROUBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-1033
Mailing Address - Country:US
Mailing Address - Phone:502-774-8631
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-772-8189
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30033207V00000X
CAG72946207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2623OtherBCBS
KY1051306OtherPASSPORT
KY64300338Medicaid
KY2623OtherBCBS
KY64300338Medicaid