1649241415 NPI number — DR. ROGER MICHAEL ANGELELLI PH.D

Table of content: DR. ROGER MICHAEL ANGELELLI PH.D (NPI 1649241415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649241415 NPI number — DR. ROGER MICHAEL ANGELELLI PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANGELELLI
Provider First Name:
ROGER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
M

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:
1649241415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 LEWIS RUN RD
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15122-3056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-466-5550
Provider Business Mailing Address Fax Number:
412-466-8741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 LEWIS RUN RD
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15122-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-466-5550
Provider Business Practice Location Address Fax Number:
412-466-8741
Provider Enumeration Date:
01/30/2006

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: 237600000X , with the licence number:  AT000196L , 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: 007049086 0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 282113 . This is a "IND. PROVIDER BLUE C/S" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: C19732 . This is a "PALMETTO(GBA) RAILROAD M" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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