Provider Demographics
NPI:1194786251
Name:CANGCUESTA, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:CANGCUESTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 SOUTH AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-3620
Mailing Address - Country:US
Mailing Address - Phone:804-504-0530
Mailing Address - Fax:804-504-0532
Practice Address - Street 1:930 SOUTH AVE STE 4B
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3620
Practice Address - Country:US
Practice Address - Phone:804-504-0530
Practice Address - Fax:804-504-0532
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036702174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
040009007OtherMEDICARE RAILROAD
040009006OtherMEDICARE RAILRAOD
C03320Medicare PIN
040009006OtherMEDICARE RAILRAOD
040009007OtherMEDICARE RAILROAD