Provider Demographics
NPI:1043044589
Name:CANNAN, GINGER LEE (PA)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:LEE
Last Name:CANNAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42740 AVERY RD
Mailing Address - Street 2:
Mailing Address - City:NATURAL BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13665-3127
Mailing Address - Country:US
Mailing Address - Phone:315-681-3149
Mailing Address - Fax:
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine