Healthcare Provider Details

I. General information

NPI: 1740472869
Provider Name (Legal Business Name): DR. CATHERINE CAGIANNOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 CASTLEGROVE BLVD
LONDON ONTARIO
N6G3T3
CA

IV. Provider business mailing address

97 CASTLEGROVE BLVD
LONDON ONTARIO
N6G3T3
CA

V. Phone/Fax

Practice location:
  • Phone: 15196574783
  • Fax:
Mailing address:
  • Phone: 15196574783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number35.083528C
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34950
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number34950
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number34950
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.083528C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: