Provider Demographics
NPI:1306858360
Name:CANINO, ADA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:IRIS
Last Name:CANINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 S BROAD ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1613
Mailing Address - Country:US
Mailing Address - Phone:215-685-6769
Mailing Address - Fax:215-685-6732
Practice Address - Street 1:321 W GIRARD AVE
Practice Address - Street 2:HEALTH CARE CENTER #6
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-1531
Practice Address - Country:US
Practice Address - Phone:215-685-3803
Practice Address - Fax:215-685-3848
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019222E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006912310003Medicaid
PA0006912310003Medicaid
PACA083100Medicare ID - Type Unspecified