Provider Demographics
NPI:1497553028
Name:CANNON, ROBERT II
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:CANNON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:MATHER
Mailing Address - State:PA
Mailing Address - Zip Code:15346-0192
Mailing Address - Country:US
Mailing Address - Phone:724-998-5864
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 192
Practice Address - Street 2:
Practice Address - City:MATHER
Practice Address - State:PA
Practice Address - Zip Code:15346-0192
Practice Address - Country:US
Practice Address - Phone:724-998-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6427604343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)