Healthcare Provider Details

I. General information

NPI: 1629025234
Provider Name (Legal Business Name): ROBERT G CANADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

IV. Provider business mailing address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-3010
  • Fax: 540-899-9821
Mailing address:
  • Phone: 540-371-3010
  • Fax: 540-899-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101239758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: