Healthcare Provider Details

I. General information

NPI: 1568103612
Provider Name (Legal Business Name): ABIGALE CANNON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 POWERS BLVD
PARMA OH
44129-5437
US

IV. Provider business mailing address

7007 POWERS BLVD
PARMA OH
44129-5437
US

V. Phone/Fax

Practice location:
  • Phone: 440-743-4020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34.017188
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: