Provider Demographics
NPI:1467902403
Name:CANNING, CAITRIONA
Entity Type:Individual
Prefix:
First Name:CAITRIONA
Middle Name:
Last Name:CANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 E 123RD ST
Mailing Address - Street 2:APT 2
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4344
Mailing Address - Country:US
Mailing Address - Phone:216-544-2856
Mailing Address - Fax:
Practice Address - Street 1:1961 E 123RD ST
Practice Address - Street 2:APT 2
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4344
Practice Address - Country:US
Practice Address - Phone:216-544-2856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.028969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine