Healthcare Provider Details

I. General information

NPI: 1831393438
Provider Name (Legal Business Name): JOHN JOSEPH CANGELOSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 DIRECTORS ROW
HOUSTON TX
77092-8703
US

IV. Provider business mailing address

4131 DIRECTORS ROW
HOUSTON TX
77092-8703
US

V. Phone/Fax

Practice location:
  • Phone: 877-697-2447
  • Fax: 855-697-2447
Mailing address:
  • Phone: 877-697-2447
  • Fax: 855-697-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number33120
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number33120
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberM7084
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: