Provider Demographics
NPI:1629025234
Name:CANADY, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:CANADY
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 1:101 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3357
Mailing Address - Country:US
Mailing Address - Phone:540-371-3010
Mailing Address - Fax:540-899-9821
Practice Address - Street 1:101 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3357
Practice Address - Country:US
Practice Address - Phone:540-371-3010
Practice Address - Fax:540-899-9821
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239758207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010290511Medicaid
VA342795OtherANTHEM BLUE CROSS BLUE SHIELD
P00327601OtherRAILROAD
VA342795OtherANTHEM BLUE CROSS BLUE SHIELD
P00327601OtherRAILROAD