Provider Demographics
NPI:1871055749
Name:KANTROWITZ, JACOB JOSEF (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:JOSEF
Last Name:KANTROWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:JOSEF
Other - Last Name:KANTROWITZ-SIROTKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5666
Mailing Address - Country:US
Mailing Address - Phone:617-506-4000
Mailing Address - Fax:
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-5666
Practice Address - Country:US
Practice Address - Phone:617-506-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP04711207R00000X
MA285073208M00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program