Provider Demographics
NPI:1477536043
Name:CANHAM, JOHN L (RPA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:CANHAM
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 WESTFALL RD
Mailing Address - Street 2:BLDG C-100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2638
Mailing Address - Country:US
Mailing Address - Phone:585-271-2800
Mailing Address - Fax:585-271-0375
Practice Address - Street 1:919 WESTFALL RD
Practice Address - Street 2:BLDG C-100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2638
Practice Address - Country:US
Practice Address - Phone:585-271-2800
Practice Address - Fax:585-271-0375
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6959364SE0003X
NY006959363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02650553Medicaid
162597BTOtherPREFERRED CARE
P019006959OtherEXCELLUS
NYQ39569Medicare UPIN