Provider Demographics
NPI:1407866296
Name:CANAVAN, TIMOTHY PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:CANAVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLAZA
Mailing Address - Street 2:3RD FL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202
Mailing Address - Country:US
Mailing Address - Phone:315-464-4458
Mailing Address - Fax:315-464-6388
Practice Address - Street 1:90 PRESIDENTIAL PLAZA
Practice Address - Street 2:3RD FL
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202
Practice Address - Country:US
Practice Address - Phone:315-464-4458
Practice Address - Fax:315-464-6388
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052441L207VM0101X
TNMD59651207VM0101X
NY179108207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40337Medicare UPIN