Provider Demographics
NPI:1902269533
Name:CANTERBURY, ANN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506A MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-246-2400
Mailing Address - Fax:513-246-4047
Practice Address - Street 1:10506A MONTGOMERY ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-246-2400
Practice Address - Fax:513-246-4047
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD477741207R00000X
PA390200000X
OH35.150984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program