Provider Demographics
NPI:1205805298
Name:MENON, KANTHI (MD)
Entity type:Individual
Prefix:DR
First Name:KANTHI
Middle Name:
Last Name:MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-1723
Mailing Address - Country:US
Mailing Address - Phone:724-770-9095
Mailing Address - Fax:724-770-9096
Practice Address - Street 1:176 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:PA
Practice Address - Zip Code:15074-1723
Practice Address - Country:US
Practice Address - Phone:724-770-9095
Practice Address - Fax:724-770-9096
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070338L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017901900001Medicaid
PAH12962Medicare UPIN