Provider Demographics
NPI:1386888733
Name:CANNELL, JEREMY DAVID (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:CANNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:703 RIVERWAY PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6745
Mailing Address - Country:US
Mailing Address - Phone:603-627-1661
Mailing Address - Fax:603-669-6944
Practice Address - Street 1:703 RIVERWAY PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6745
Practice Address - Country:US
Practice Address - Phone:603-627-1661
Practice Address - Fax:603-669-6944
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2023-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH236572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology