Basic Information
Provider Information | |||||||||
NPI: | 1306845375 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CANAN | ||||||||
FirstName: | PATRICK | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 12622 | ||||||||
Address2: |   | ||||||||
City: | BELFAST | ||||||||
State: | ME | ||||||||
PostalCode: | 049154017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4434816572 | ||||||||
FaxNumber: | 4434816515 | ||||||||
Practice Location | |||||||||
Address1: | 2002 MEDICAL PKWY | ||||||||
Address2: | SUITE 670 | ||||||||
City: | ANNAPOLIS | ||||||||
State: | MD | ||||||||
PostalCode: | 214013046 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4434811150 | ||||||||
FaxNumber: | 4102240065 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2005 | ||||||||
LastUpdateDate: | 12/03/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H0056619 | MD | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 262679 | 01 | MD | KAISER | OTHER | 606897000 | 01 | MD | FEDERAL WORKMAN'S COMP | OTHER | 7223307 | 01 | MD | AETNA PPO | OTHER | 0004 | 01 | DC | BCBS | OTHER | 2133450 | 01 | MD | MAMSI | OTHER | 61009902 | 01 | MD | BCBS | OTHER | 2701143 | 01 | MD | AETNA HMO | OTHER | 2096584 | 01 | MD | UNITED HEALTHCARE | OTHER | 807301500 | 05 | MD |   | MEDICAID | 9597962002 | 01 | MD | CIGNA | OTHER |