Provider Demographics
NPI:1366852824
Name:CANAVAN, JOYCELIN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYCELIN
Middle Name:F
Last Name:CANAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ASPIRA CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4125
Mailing Address - Country:US
Mailing Address - Phone:419-756-2122
Mailing Address - Fax:419-756-3530
Practice Address - Street 1:1125 ASPIRA CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4125
Practice Address - Country:US
Practice Address - Phone:419-756-2122
Practice Address - Fax:419-756-3530
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04371692085R0001X
MO20140087082085R0001X
OH1297482085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1366852824Medicaid
KS201096380CMedicaid
KS201096380BMedicaid
MO1366852824Medicaid
KS201096380CMedicaid
OHH532820Medicare PIN