Provider Demographics
NPI:1033219654
Name:ANGOTTI, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:ANGOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:527 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9008
Mailing Address - Country:US
Mailing Address - Phone:681-342-3500
Mailing Address - Fax:
Practice Address - Street 1:527 MEDICAL PARK DR
Practice Address - Street 2:SUITE 307
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9008
Practice Address - Country:US
Practice Address - Phone:304-933-3332
Practice Address - Fax:304-933-3318
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV14700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070618000Medicaid
WVA72425Medicare UPIN
WV0070618000Medicaid
WV0585513Medicare PIN