Provider Demographics
NPI:1942206073
Name:CANGEMI, PAUL J (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:CANGEMI
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 1:174 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9758
Mailing Address - Country:US
Mailing Address - Phone:513-523-4482
Mailing Address - Fax:
Practice Address - Street 1:10 N LOCUST ST
Practice Address - Street 2:STE 1B
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1182
Practice Address - Country:US
Practice Address - Phone:513-524-1100
Practice Address - Fax:513-524-0085
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2009-01-12
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
OH35-036511207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420020Medicaid
IN100001310Medicaid
OH2000017810OtherRAILROAD MEDICARE
OHA74770Medicare UPIN
OHCA0399191Medicare ID - Type Unspecified
IN100001310Medicaid