Provider Demographics
NPI:1962496539
Name:CANCIAN, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CANCIAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:330 MOUNT AUBURN ST
Mailing Address - Street 2:PARSONS 2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5597
Mailing Address - Country:US
Mailing Address - Phone:617-926-9000
Mailing Address - Fax:617-926-7053
Practice Address - Street 1:480 PLEASANT ST # A300
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2463
Practice Address - Country:US
Practice Address - Phone:617-926-9000
Practice Address - Fax:617-926-7053
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78517207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2078821Medicaid
MA2078821Medicaid
A56272Medicare UPIN