Provider Demographics
NPI:1790882421
Name:CANARIA, APOLONIO CACHOLA JR (MD)
Entity Type:Individual
Prefix:
First Name:APOLONIO
Middle Name:CACHOLA
Last Name:CANARIA
Suffix:JR
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 1:13107 QUAIL CREEK CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3588
Mailing Address - Country:US
Mailing Address - Phone:301-622-0909
Mailing Address - Fax:
Practice Address - Street 1:50 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8292
Practice Address - Fax:202-745-8293
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19575207L00000X
MDD0042687207L00000X
VA0101047577207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216721200Medicaid
MD216721200Medicaid