Individual
VITALY KANTOROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-5351
(860) 679-3245
(860) 679-1867
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
051169
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902914724
—
CT
Enumeration date
08/29/2006
Last updated
08/09/2012
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