Healthcare Provider Details

I. General information

NPI: 1417140922
Provider Name (Legal Business Name): HAMDEN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WASHINGTON AVE
HAMDEN CT
06518-3267
US

IV. Provider business mailing address

9 WASHINGTON AVE
HAMDEN CT
06518-3267
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-0552
  • Fax: 203-287-1426
Mailing address:
  • Phone: 203-287-0552
  • Fax: 203-287-1426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number020653
License Number StateCT

VIII. Authorized Official

Name: DR. CHRISTOPHER RICHARD CANNY
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 203-287-0552