Provider Demographics
NPI:1902223118
Name:CANNON, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:CANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6535 N CHARLES ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5824
Mailing Address - Country:US
Mailing Address - Phone:410-427-3900
Mailing Address - Fax:410-938-8461
Practice Address - Street 1:6535 N CHARLES ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5824
Practice Address - Country:US
Practice Address - Phone:410-427-3900
Practice Address - Fax:410-938-8461
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD827092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry