Healthcare Provider Details

I. General information

NPI: 1851488621
Provider Name (Legal Business Name): SARAH CANAVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH SNELGROVE MD

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 WATERFORD PKWY S STE 306
WATERFORD CT
06385-1234
US

IV. Provider business mailing address

410 SAYBROOK RD SUITE 201
MIDDLETOWN CT
06457-4777
US

V. Phone/Fax

Practice location:
  • Phone: 604-472-4898
  • Fax: 860-737-1231
Mailing address:
  • Phone: 860-347-4620
  • Fax: 860-346-9687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number042602
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: