Provider Demographics
NPI:1902891104
Name:CANCADO, PAULO J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULO
Middle Name:J
Last Name:CANCADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 W 10TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6304
Mailing Address - Country:US
Mailing Address - Phone:509-585-5972
Mailing Address - Fax:509-586-5701
Practice Address - Street 1:216 W 10TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6300
Practice Address - Country:US
Practice Address - Phone:509-585-5972
Practice Address - Fax:509-586-5701
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00000337342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1116714Medicaid
WA8936953OtherCRIME VICTIMS NUMBER
WA0160721OtherLABOR & INDUSTRIES #
WA0160721OtherLABOR & INDUSTRIES #
WAGAB29035Medicare ID - Type UnspecifiedINDIVIDUAL MC NUMBER
WA1116714Medicaid