Basic Information
| Provider Information | |||||||||
| NPI: | 1851507073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANTROW | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 21ST AVE S | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372124908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153279797 | ||||||||
| FaxNumber: | 6156130329 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 21ST AVE S | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372124908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153279797 | ||||||||
| FaxNumber: | 6156130329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ND0900X | 42115 | TN | Y | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207N00000X | 42115 | TN | N | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | FK0201450 | 01 | TN | DEA | OTHER |