Provider Demographics
NPI:1619051711
Name:CANAVAN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CANAVAN
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 1:10 COACH DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1565
Mailing Address - Country:US
Mailing Address - Phone:609-896-3851
Mailing Address - Fax:
Practice Address - Street 1:PROFESSIONAL ASSISTANCE PROGRAM OF NJ
Practice Address - Street 2:742 ALEXANDER ROAD
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08650
Practice Address - Country:US
Practice Address - Phone:609-919-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine