1679773667 NPI number — ROBERT C. CANTU MD NEUROLOGICAL SURGERY, INC.

Table of content: (NPI 1679773667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679773667 NPI number — ROBERT C. CANTU MD NEUROLOGICAL SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT C. CANTU MD NEUROLOGICAL SURGERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1679773667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 ORNAC
Provider Second Line Business Mailing Address:
JOHN CUMING BUILDING SUITE 820
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742-4181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-369-1386
Provider Business Mailing Address Fax Number:
978-287-0047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 ORNAC
Provider Second Line Business Practice Location Address:
JOHN CUMING BUILDING SUITE 820
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-1386
Provider Business Practice Location Address Fax Number:
978-287-0047
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANTU
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
CLARK
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
978-369-1386

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  28386 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: M01876 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: M10876 . This is a "MEDICARE TYPE UNSPECIFIED" identifier . This identifiers is of the category "OTHER".




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