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General NPI Number Information
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NPI Number | 1891739991
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Entity Type | Individual
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Provider Name | MICHAEL T CANAVAN DPM
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 789 PINEY FOREST RD SUITE B
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City | DANVILLE
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State | VA
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Zip | 24540-2877
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Country | US
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Telephone | 434-799-9430
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Fax | 434-792-8438
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Provider Business Mailing Address
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Address Line | 789 PINEY FOREST RD SUITE B
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City | DANVILLE
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State | VA
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Zip | 24540-2877
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Country | US
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Telephone | 434-799-9430
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Fax | 434-792-8438
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103 000583
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 219
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License Number State | NC
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