Healthcare Provider Details

I. General information

NPI: 1215382494
Provider Name (Legal Business Name): MARGAUX MARIE CANEVARI DO, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

IV. Provider business mailing address

350 W 11TH ST
INDIANAPOLIS IN
46202-4108
US

V. Phone/Fax

Practice location:
  • Phone: 410-581-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberH0103423
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0102204970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: