Provider Demographics
NPI:1760575385
Name:CANADAY, MAURICE L (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:L
Last Name:CANADAY
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:PO BOX 601448
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260
Mailing Address - Country:US
Mailing Address - Phone:704-543-6636
Mailing Address - Fax:704-541-9476
Practice Address - Street 1:7810 PROVIDENCE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:704-541-9476
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1098Medicaid
NC8921000Medicaid
NC205263VMedicare PIN
NC205263DMedicare PIN
NC205263FMedicare PIN
NC8921000Medicaid
NC205263LMedicare PIN
NC205263MMedicare PIN
NC205263WMedicare PIN
NC205263GMedicare PIN
NC205263EMedicare ID - Type UnspecifiedCHUC - ARBORETUM
SCNC1098Medicaid
NC205263HMedicare PIN
NC205263TMedicare PIN
NC205263UMedicare PIN
NCC83126Medicare UPIN
NC205263XMedicare PIN