Healthcare Provider Details

I. General information

NPI: 1972522076
Provider Name (Legal Business Name): JENNIFER PAPA KANAAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE THE PAT AND JIM CALHOUN CARDIOLOGY CENTER
FARMINGTON CT
06030-1321
US

IV. Provider business mailing address

263 FARMINGTON AVE DEPARTMENT OF PULMONARY MEDICINE
FARMINGTON CT
06030-1321
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3343
  • Fax: 860-679-4256
Mailing address:
  • Phone: 860-679-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number040794
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number040794
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: