Provider Demographics
NPI:1922097260
Name:CANTELMO, NANCY LEE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:CANTELMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIANS ORGANIZATION INC
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WANG ACC 440
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-4464
Practice Address - Fax:617-643-4752
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA439982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAN01926OtherBLUE CROSS BLUE SHIELD
MA141917Medicaid
MAA32134Medicare ID - Type Unspecified
MA141917Medicaid