Organization
JERROLD S. CANAKIS, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERROLD S CANAKIS M.D. (OWNER)
(410) 641-2938
Entity
Organization
Contact information
Practice address
10344 OLD OCEAN CITY BLVD, BLVD #1, BERLIN, MD 21811-1162
(410) 641-2938
(410) 641-4904
Mailing address
PO BOX 242, BERLIN, MD 21811-0242
(410) 641-9450
(410) 641-4904
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100016996
RAILROAD MEDICARE
DE
01
—
100016996
RAILROAD MEDICARE
MD
Enumeration date
12/06/2007
Last updated
07/26/2012
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