Provider Demographics
NPI:1033517370
Name:UMSTEAD, ANGELA (ED S)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:UMSTEAD
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676-8904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:598 N MARKET ST
Practice Address - Street 2:
Practice Address - City:SHREVE
Practice Address - State:OH
Practice Address - Zip Code:44676-8904
Practice Address - Country:US
Practice Address - Phone:330-567-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3022008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3022008Medicaid