Provider Demographics
NPI:1336165968
Name:KANTESARIA, KIRTIKANT P (MD)
Entity Type:Individual
Prefix:
First Name:KIRTIKANT
Middle Name:P
Last Name:KANTESARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:40 WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1138
Mailing Address - Country:US
Mailing Address - Phone:413-283-7651
Mailing Address - Fax:413-284-5117
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5114
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA48473207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000252OtherUNITED HEALTHCARE
4390336OtherHEALTHSOURCE CMHC
984960OtherNETWORK HEALTH
048473OtherTUFTS COMMUNITY HEALTH PL
MS9748284Medicaid
10035501OtherCIGNA
19528OtherHARVARD PILGRIM
N01963OtherBLUE CROSS BLUE SHIELD
1428OtherFALLON COMMUNITY HEALTH P
A67917Medicare UPIN
048473OtherTUFTS COMMUNITY HEALTH PL