Provider Demographics
NPI:1730122193
Name:KANTER, STUART JAMES (DO)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:JAMES
Last Name:KANTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0378
Mailing Address - Country:US
Mailing Address - Phone:888-531-7444
Mailing Address - Fax:614-867-9889
Practice Address - Street 1:590 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1436
Practice Address - Country:US
Practice Address - Phone:888-531-7444
Practice Address - Fax:614-867-9889
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008510207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667252Medicaid
OH7357801Medicare PIN