Provider Demographics
NPI:1811936065
Name:CANTOR, ADRIANNE L (MD)
Entity type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:L
Last Name:CANTOR
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 1:2000 OLD WEST CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-536-2100
Mailing Address - Fax:610-536-2400
Practice Address - Street 1:2000 OLD WEST CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-536-2100
Practice Address - Fax:610-536-2400
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427238207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-2359401OtherMLHC TIN
PA099102N2PMedicare PIN
PA1020272760001Medicaid
PA23-2359401OtherMLHC TIN
PAP00394586Medicare PIN