Basic Information
Provider Information | |||||||||
NPI: | 1275539421 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KANTSIPER | ||||||||
FirstName: | MELINDA | ||||||||
MiddleName: | ELLEN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BARD | ||||||||
OtherFirstName: | MELINDA | ||||||||
OtherMiddleName: | ELLEN | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5755 CEDAR LN | ||||||||
Address2: | HOWARD COUNTY GENERAL HOSPITAL -CIMS | ||||||||
City: | COLUMBIA | ||||||||
State: | MD | ||||||||
PostalCode: | 210442912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108844644 | ||||||||
FaxNumber: | 4108844643 | ||||||||
Practice Location | |||||||||
Address1: | 5755 CEDAR LN | ||||||||
Address2: | HOWARD COUNTY GENERAL HOSPITAL -CIMS | ||||||||
City: | COLUMBIA | ||||||||
State: | MD | ||||||||
PostalCode: | 210442912 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108844644 | ||||||||
FaxNumber: | 4108844643 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2005 | ||||||||
LastUpdateDate: | 10/22/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D56245 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.