Individual
DR. RYAN CANISSARIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11958 W BROAD ST, HENRICO, VA 23233-1007
(804) 828-9350
Mailing address
PO BOX 980599, RICHMOND, VA 23298-0599
(804) 682-8963
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
0101274874
VA
Other
Enumeration date
04/27/2016
Last updated
10/31/2022
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