Organization
SOUTHSIDE HEAD N NECK SURGERY PROFESSIONAL CORP
Active
Other names
Southside Ear, Nose & Throat
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CANGCUESTA M.D. (PHYSICIAN/OWNER)
(804) 337-1110
Entity
Organization
Contact information
Practice address
930 SOUTH AVE., SUITE 4B, COLONIAL HEIGHTS, VA 23834
(804) 504-0530
(804) 504-0532
Mailing address
930 SOUTH AVE., SUITE 4B, COLONIAL HEIGHTS, VA 23834
(804) 504-0530
(804) 504-0532
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101036702
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006555055
MEDICARE RAILROAD
VA
01
—
040009007
MEDICARE RAILROAD
VA
01
—
P00002082
MEDICARE RAILROAD
VA
01
—
P00002088
MEDICARE RAILROAD
VA
Enumeration date
11/02/2006
Last updated
07/01/2014
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