Healthcare Provider Details

I. General information

NPI: 1891739991
Provider Name (Legal Business Name): MICHAEL T CANAVAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 03/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 PINEY FOREST RD SUITE B
DANVILLE VA
24540-2877
US

IV. Provider business mailing address

789 PINEY FOREST RD SUITE B
DANVILLE VA
24540-2877
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-9430
  • Fax: 434-792-8438
Mailing address:
  • Phone: 434-799-9430
  • Fax: 434-792-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103 000583
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number219
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: