Provider Demographics
NPI:1700076908
Name:CANNON, CECILY (DO)
Entity Type:Individual
Prefix:DR
First Name:CECILY
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SUMMER STREET
Mailing Address - Street 2:KENNEBUNK FAMILY PRACTICE
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043
Mailing Address - Country:US
Mailing Address - Phone:207-985-2453
Mailing Address - Fax:
Practice Address - Street 1:103 SUMMER STREET
Practice Address - Street 2:KENNEBUNK FAMILY PRACTICE
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-985-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine