Provider Demographics
NPI:1043235427
Name:DEJULIUS, ANGELA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:JANE
Last Name:DEJULIUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 OLD FORGE RD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6744
Mailing Address - Country:US
Mailing Address - Phone:330-678-1746
Mailing Address - Fax:330-678-6716
Practice Address - Street 1:1365 KELSO RD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-297-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.071263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015929Medicaid
OHG39984Medicare UPIN
OH2015929Medicaid