Provider Demographics
NPI:1508866724
Name:CANGELOSI, ROBERT JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:CANGELOSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 FRENCHMEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-3839
Mailing Address - Country:US
Mailing Address - Phone:504-282-7212
Mailing Address - Fax:504-282-7657
Practice Address - Street 1:4201 FRENCHMEN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-3839
Practice Address - Country:US
Practice Address - Phone:504-282-7212
Practice Address - Fax:504-282-7657
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7199207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035581Medicaid
LA5J428Medicare ID - Type Unspecified
LAB60468Medicare UPIN