Provider Demographics
NPI:1669623088
Name:CANNAVA, JOHN JOSEPH JR (LDRD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JOSEPH
Last Name:CANNAVA
Suffix:JR
Gender:M
Credentials:LDRD
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Mailing Address - Street 1:186 CAMBRIDGE RD
Mailing Address - Street 2:SUITE #11
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-938-6392
Mailing Address - Fax:781-938-7412
Practice Address - Street 1:186 CAMBRIDGE RD
Practice Address - Street 2:SUITE #11
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-938-6392
Practice Address - Fax:781-938-7412
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
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Provider Licenses
StateLicense IDTaxonomies
MA266133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA39478OtherHARVARD
MALD0064OtherBLUE CROSS