MEDICARE: DR. DAVID C CANGCUESTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101036702	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040009007	OTHER		MEDICARE RAILROAD
2	040009006	OTHER		MEDICARE RAILRAOD

General Provider Information

NPI Number	:	1194786251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID C CANGCUESTA MD

Provider Business Mailing Address
First Line	:	930 SOUTH AVE STE 4B
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-504-0530
Fax Number	:	804-504-0532

Provider Business Practice Location Address
First Line	:	930 SOUTH AVE STE 4B
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-3620
Country	:	US
Telephone Number	:	804-504-0530
Fax Number	:	804-504-0532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	04/03/2014

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