Provider Demographics
NPI:1609824036
Name:CANTY, JOHN M JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CANTY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SUNY AT BUFFALO
Mailing Address - Street 2:MEDICAL AND RESEARCH BLDG ROOM 345
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-3001
Mailing Address - Country:US
Mailing Address - Phone:716-829-2684
Mailing Address - Fax:
Practice Address - Street 1:3980 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1727
Practice Address - Country:US
Practice Address - Phone:716-882-6544
Practice Address - Fax:716-882-6833
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY146559207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010025401OtherEXCELLUS UNIVERA
NY2107598OtherINDEPENDENT HEALTH
NY005000661OtherHEALTH NOW
NY01621645Medicaid
110008835Medicare PIN
NY005000661OtherHEALTH NOW
NY2107598OtherINDEPENDENT HEALTH