Provider Demographics
NPI:1174723175
Name:CANARY, MICHAEL CLARENCE (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CLARENCE
Last Name:CANARY
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOLIDAY CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7003
Mailing Address - Country:US
Mailing Address - Phone:410-224-4327
Mailing Address - Fax:410-573-1914
Practice Address - Street 1:130 HOLIDAY CT
Practice Address - Street 2:SUITE 105
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7003
Practice Address - Country:US
Practice Address - Phone:410-224-4327
Practice Address - Fax:410-573-1914
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02427237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist