Provider Demographics
NPI:1962460295
Name:CANNER, GARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:CANNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2201 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1189
Mailing Address - Country:US
Mailing Address - Phone:610-375-4949
Mailing Address - Fax:610-375-6233
Practice Address - Street 1:2201 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1189
Practice Address - Country:US
Practice Address - Phone:610-375-4949
Practice Address - Fax:610-375-6233
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022054E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108461Medicare PIN
PAB36750Medicare UPIN