Provider Demographics
NPI:1114006608
Name:CANOS, PORTIA V C (MD)
Entity type:Individual
Prefix:DR
First Name:PORTIA
Middle Name:V C
Last Name:CANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9085
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9085
Mailing Address - Country:US
Mailing Address - Phone:740-532-0220
Mailing Address - Fax:740-532-5088
Practice Address - Street 1:1920 S 9TH ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-2453
Practice Address - Country:US
Practice Address - Phone:740-532-0220
Practice Address - Fax:740-532-5088
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35495207Q00000X
KY21220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212997Medicaid
KY64212202Medicaid
KYH154450Medicare PIN
OH0212997Medicaid
KY64212202Medicaid
OHCA9318811Medicare ID - Type Unspecified