Provider Demographics
NPI:1992774780
Name:CANARY, CATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:CANARY
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 1:7B JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3003
Mailing Address - Country:US
Mailing Address - Phone:518-782-7733
Mailing Address - Fax:518-782-0800
Practice Address - Street 1:7B JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3003
Practice Address - Country:US
Practice Address - Phone:518-782-7733
Practice Address - Fax:518-782-0800
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1743212080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01607432Medicaid
NY091112000034OtherFIDELIS
NY7425867OtherAETNA
NY143311OtherGHI/HMO
NYPRC200204488OtherCDPHP
NY9042527OtherMVP HEALTHCARE
NY5125M1OtherEMPIRE BC
NY7425867OtherAETNA