Individual
MAMIE K CANTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
830 HARRISON AVE, STE 3400, BOSTON, MA 02118-2905
(617) 414-4861
(617) 414-3617
Mailing address
720 HARRISON AVE DOB 503, PROVIDER ENROLLMENT, BOSTON, MA 02118-2905
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5556
MA
363AM0700X
Medical Physician Assistant
PA5556
MA
Other
Enumeration date
11/17/2015
Last updated
10/25/2018
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