MEDICARE: DR. GLEN C CANGELOSI 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	207W00000X	Ophthalmology Physician	016166	LA

General Provider Information

NPI Number	:	1326048398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN C CANGELOSI MD

Provider Business Mailing Address
First Line	:	4201 FRENCHMEN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3839
Country	:	US
Telephone Number	:	504-282-7212
Fax Number	:	504-282-7657

Provider Business Practice Location Address
First Line	:	4201 FRENCHMEN ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70122-3839
Country	:	US
Telephone Number	:	504-282-7212
Fax Number	:	504-282-7657

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	08/21/2012

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