Basic Information
| Provider Information | |||||||||
| NPI: | 1619266913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANHAM | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 PORTLAND AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852662010 | ||||||||
| FaxNumber: | 5852665363 | ||||||||
| Practice Location | |||||||||
| Address1: | 1445 PORTLAND AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146213008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852662010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2011 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 289254 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.