Provider Demographics
NPI:1245368695
Name:CANNAVA, MATHEW M (MD)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:M
Last Name:CANNAVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-0780
Mailing Address - Country:US
Mailing Address - Phone:907-262-7546
Mailing Address - Fax:907-262-7599
Practice Address - Street 1:247 N FIREWEED ST
Practice Address - Street 2:STE B
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7540
Practice Address - Country:US
Practice Address - Phone:907-262-7546
Practice Address - Fax:907-262-7599
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAK4179207N00000X, 207ND0101X, 207ND0900X, 207NI0002X, 207NP0225X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD16711Medicaid
AKH62672Medicare UPIN
AKMD16711Medicaid