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General NPI Number Information
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NPI Number | 1124200951
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Entity Type | Organization
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Legal Business Name | CANADY SURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 100 STOOPS DRIVE SUITE 230
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City | MONONGAHELA
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State | PA
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Zip | 15063-3556
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Country | US
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Telephone | 724-483-3639
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Fax | 724-483-3758
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Provider Business Mailing Address
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Address Line | 100 STOOPS DRIVE SUITE 230
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City | MONONGAHELA
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State | PA
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Zip | 15063-3553
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Country | US
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Telephone | 724-483-3639
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Fax | 724-483-3758
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEROME CANADY
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Credential | M.D.
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Telephone | 724-483-3639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD093942
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License Number State | PA
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