Basic Information
| Provider Information | |||||||||
| NPI: | 1538160734 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CANTOR | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12623 ECKEL JUNCTION RD STE 2600 | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435511304 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12623 ECKEL JUNCTION RD STE 2600 | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435511304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5673681700 | ||||||||
| FaxNumber: | 5673681701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 04/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35082449 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000476566 | 01 | OH | ANTHEM | OTHER | P00370414 | 01 | OH | RRMC | OTHER | 06036 | 01 | OH | PARAMOUNT | OTHER | 2593126 | 05 | OH | MEDICAID | 7847795 | 01 | OH | AETNA | OTHER |