Provider Demographics
NPI:1467486944
Name:CANNON, CHRISTOPHER SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:CANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 TECHNOLOGY PKWY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9400
Mailing Address - Country:US
Mailing Address - Phone:717-732-8182
Mailing Address - Fax:717-732-8839
Practice Address - Street 1:2025 TECHNOLOGY PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9400
Practice Address - Country:US
Practice Address - Phone:717-732-8182
Practice Address - Fax:717-732-8839
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044026E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655151Medicare ID - Type Unspecified
PAE73748Medicare UPIN