Provider Demographics
NPI:1023182383
Name:CANTON, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:CANTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:CARLOS
Other - Last Name:CANTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:390 TOLL GATE ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886
Mailing Address - Country:US
Mailing Address - Phone:401-737-0005
Mailing Address - Fax:401-737-9880
Practice Address - Street 1:390 TOLL GATE ROAD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886
Practice Address - Country:US
Practice Address - Phone:401-737-0005
Practice Address - Fax:401-737-9880
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD083612084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
203814OtherBLUE CHIP
0005431222OtherAETHA
4946763OtherCIGNA
767476OtherTUFTS
RI9020231Medicaid
RI202318OtherBCBS
7500061OtherUNITED HEALTH
7500061OtherUNITED HEALTH
0005431222OtherAETHA