Individual
LAURALYN B. CANNISTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
131 BEECHWOOD AVENUE, PAWTUCKET, RI 02860
(401) 475-1999
(401) 475-6932
Mailing address
131 BEECHWOOD AVENUE, PAWTUCKET, RI 02860
(401) 475-1999
(401) 475-6932
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
75195
MA
207RC0000X
Cardiovascular Disease Physician
Primary
MD08607
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007057418
MEDICARE PTAN
RI
05
—
9006817
—
RI
Enumeration date
03/28/2006
Last updated
07/21/2022
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