Provider Demographics
NPI:1932162104
Name:CANNING, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:CANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:163 LIBBEY PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3101
Mailing Address - Country:US
Mailing Address - Phone:781-337-4224
Mailing Address - Fax:781-335-0429
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-340-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15177207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ17824OtherBLUE SHIELD
MA273479OtherHARVARD PILGRIM
MA37767OtherFALLON
MA3168123Medicaid
MA3168123OtherHEALTHY START
MA767488OtherTUFTS
MA3168123OtherHEALTHY START
MA767488OtherTUFTS
MA37767OtherFALLON
MAA22824Medicare PIN