Provider Demographics
NPI:1275639361
Name:MCCANCE, DAVID MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:MCCANCE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9302 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9142
Mailing Address - Country:US
Mailing Address - Phone:843-553-8730
Mailing Address - Fax:843-553-8767
Practice Address - Street 1:9302 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE B
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9142
Practice Address - Country:US
Practice Address - Phone:843-553-8730
Practice Address - Fax:843-553-8767
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007200207RG0100X
SC1233207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1404919Medicaid
MI54600105OtherBCBS-MI
MI2909004Medicaid
SCPTAN 9228Medicare PIN
MIB43097Medicare UPIN
MI1404919Medicaid