Provider Demographics
NPI:1528206034
Name:CANNON, RICHARD OVERTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:OVERTON
Last Name:CANNON
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 CENTER DR
Mailing Address - Street 2:BUILDING 10-CRC ROOM 5-3330
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20892-0001
Mailing Address - Country:US
Mailing Address - Phone:301-496-9895
Mailing Address - Fax:301-402-0888
Practice Address - Street 1:10 CENTER DR
Practice Address - Street 2:BUILDING 10-CRC ROOM 5-3330
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:301-496-9895
Practice Address - Fax:301-402-0888
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
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Provider Licenses
StateLicense IDTaxonomies
MDD0025161207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease