1528061983 NPI number — DR. WENDY A ANGELO M.D.

Table of content: DR. WENDY A ANGELO M.D. (NPI 1528061983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528061983 NPI number — DR. WENDY A ANGELO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGELO
Provider First Name:
WENDY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528061983
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 E THOMAS RD BLDG 2108
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85016-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-933-1813
Provider Business Mailing Address Fax Number:
602-933-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
879 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-357-8198
Provider Business Practice Location Address Fax Number:
602-933-0222
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  48304 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 10892 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD056517L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30200740 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 578117NWB . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 12561940 . This is a "MULTIPLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "PRIVATE HEALTHCARE ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2547667 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30703781 . This is a "AMERIHEALTH CARITAS & VIP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 888567 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: QZZ000000208841 . This is a "AETNA BETTER HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 371509 . This is a "MVP ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 713530 . This is a "HARVARD PILGRIM ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3017025 . This is a "AETNA ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 35973 . This is a "CIGNA ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P023475 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 003607668 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 103284080 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 222594672 . This is a "TRICARE ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "GREATWEST HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7599428 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01YP02430NH01 . This is a "ANETHEM ID#" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 222594672 . This is a "UNITED HEALTHCARE ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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