Healthcare Provider Details

I. General information

NPI: 1477602266
Provider Name (Legal Business Name): MEGAN MARIE CANALE GLOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN MARIE CANALE PA

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E GENESEE ST
SYRACUSE NY
13210-1912
US

IV. Provider business mailing address

1120 E GENESEE ST
SYRACUSE NY
13210-1912
US

V. Phone/Fax

Practice location:
  • Phone: 315-475-5540
  • Fax: 315-475-5554
Mailing address:
  • Phone: 315-475-5540
  • Fax: 315-475-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number011864
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: