Jermaine Cannon, LMT
Individual provider Active NPI Specialist · Wilmington, DE
NPI 1790396703 · NPPES record last updated Aug 13, 2020
Key facts
- NPI
- 1790396703
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- MT-0003237 (DE)
- Practice address
- 1 Murphy Rd
Wilmington, DE 19803-3044 - Phone
- (302) 543-4004
- NPI assigned
- Aug 13, 2020
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT-0003237 | DE | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MT-0003237 | DE | Yes |
Addresses
Primary practice location
1 Murphy Rd
Wilmington, DE 19803-3044
Mailing address
24 Nicole CT
New Castle, DE 19720-3762
Phone (302) 377-5838
Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.