Individual
DR. MICHAEL CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
933 FIRST COLONIAL RD, SUITE 100, VIRGINIA BEACH, VA 23454-3172
(757) 491-7359
(757) 491-9359
Mailing address
700 BATTLEFIELD BLVD N, STE A, CHESAPEAKE, VA 23320-4952
(757) 491-7359
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101229742
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010137594
VIRGINIA PREMIER
VA
05
—
010137594
—
VA
01
—
175136
ANTHEM BCBS
VA
01
—
59000245
NC MEDICAID
NC
01
—
93867
OPTIMA/SENTARA
VA
Enumeration date
10/11/2005
Last updated
11/10/2017
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