Provider Demographics
NPI:1770894974
Name:KANTEH, MARIAM (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:KANTEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 DRAPER AVE
Mailing Address - Street 2:NORTH ATTLEBOROUGH MEDICAL CENTER
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3604
Mailing Address - Country:US
Mailing Address - Phone:508-695-9421
Mailing Address - Fax:
Practice Address - Street 1:170 DRAPER AVE
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-3604
Practice Address - Country:US
Practice Address - Phone:508-699-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant