Individual
ANTHONY JOSEPH CANNISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
333 SCHOOL ST, SUITE 112, PAWTUCKET, RI 02860-5334
(401) 723-1210
(401) 312-2099
Mailing address
333 SCHOOL ST, SUITE 112, PAWTUCKET, RI 02860-5334
(401) 723-1210
(401) 312-2099
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD08606
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7004186
—
RI
01
—
J1392902
MEDICARE PTAN
RI
Enumeration date
03/28/2006
Last updated
12/01/2010
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