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Individual

DR. KEITH E CANGELOSI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
604 W 13TH AVE, COVINGTON, LA 70433-3308
(985) 871-0070
(985) 871-0046
Mailing address
604 W 13TH AVE, COVINGTON, LA 70433-3308
(985) 871-0070
(985) 871-0046

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
017231
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1366048
LA
01
P00314748
RAILROAD MEDICARE
LA
Enumeration date
10/20/2005
Last updated
05/06/2016
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