Neil F Cannon, M.D.
Individual provider Active NPI Family Medicine Physician · Holden, MA
NPI 1902894017 · NPPES record last updated Aug 30, 2010
Key facts
- NPI
- 1902894017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 36130 (MA)
- Practice address
- 11 Mayo Dr
Holden, MA 01520-1539 - Phone
- (508) 829-4355
- Fax
- (508) 829-9119
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36130 | MA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Umass Memorial Medical Group, Inc. | Past | Accepting new patients | |
| Umass Memorial Medical Group Inc | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36130 | MA | Yes |
Addresses
Primary practice location
11 Mayo Dr
Holden, MA 01520-1539
Mailing address
PO Box 415348
Boston, MA 02241-5348
Phone (800) 335-8885
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110036781A | Medicaid | MA |
Other providers in Holden, MA
- Pureza Puray Budd
- Erin E Burns
- Cristen Aileen Bussiere
- Brandon L Cairo
- C. Graham Campbell
- Sarah Cardullo
- Care Elite Nursing Agency
- Jennifer Carlson
- Stacey M Carroll
- Taylor Caruso-Fahey
All providers in Holden, MA · Family Medicine Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 30, 2010. 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.