Individual
DR. JONATHAN DAVID CANNELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-3238
(814) 375-3380
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-4200
(814) 375-4232
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
57.015239
OH
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD448035
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102845465
—
PA
01
—
302580
MEDICARE
PA
Enumeration date
09/27/2011
Last updated
02/19/2018
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