1528258423 NPI number — BRIAN THOMAS CANTERBURY M.D.

Table of content: BRIAN THOMAS CANTERBURY M.D. (NPI 1528258423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528258423 NPI number — BRIAN THOMAS CANTERBURY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANTERBURY
Provider First Name:
BRIAN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528258423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W EXCHANGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44302-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-535-4428
Provider Business Mailing Address Fax Number:
330-535-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95 ARCH ST
Provider Second Line Business Practice Location Address:
#165
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44304-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-375-4848
Provider Business Practice Location Address Fax Number:
330-252-0582
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  35-093268 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1841239274 . This is a "PARTNERS PHYSICIAN GROUP TYPE 2 NPI #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2931573 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2551671 . This is a "PARTNERS PHYSICIAN GROUP MEDICAID GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9338635 . This is a "PARTNERS PHYSICIAN GROUP MEDICARE GROUP #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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