Individual
NINO KVANTALIANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1815 JOHN F KENNEDY BLVD APT 720, PHILADELPHIA, PA 19103-1705
(470) 558-8888
Mailing address
1815 JOHN F KENNEDY BLVD APT 720, PHILADELPHIA, PA 19103-1705
(470) 558-8888
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT215375
PA
2084N0400X
Neurology Physician
Primary
MD477262
PA
Other
Enumeration date
07/27/2018
Last updated
05/05/2023
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