Provider Demographics
NPI:1962496539
Name:CANCIAN, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CANCIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:521 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4191
Mailing Address - Country:US
Mailing Address - Phone:617-924-6484
Mailing Address - Fax:617-924-6142
Practice Address - Street 1:521 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4191
Practice Address - Country:US
Practice Address - Phone:617-924-6484
Practice Address - Fax:617-924-6142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA78517207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2078821Medicaid
MA2078821Medicaid
A56272Medicare UPIN