# JERROLD S. CANAKIS, MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528241171
- **Authorized official:** JERROLD S CANAKIS M.D. (OWNER)
- **Authorized official phone:** (410) 641-2938

## Contact information

- **Practice address:** 10344 OLD OCEAN CITY BLVD, BLVD \#1, BERLIN, MD 21811-1162
- **Practice address phone:** (410) 641-2938
- **Practice address fax:** (410) 641-4904
- **Mailing address:** PO BOX 242, BERLIN, MD 21811-0242
- **Mailing address phone:** (410) 641-9450
- **Mailing address fax:** (410) 641-4904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | MD | Yes |

## Other

- **Enumeration date:** 12/06/2007
- **Last updated:** 07/26/2012