Provider Demographics
NPI:1043406150
Name:WEATHERALL, ANGELA GIANCOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:GIANCOLA
Last Name:WEATHERALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:GIANCOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7050 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:561-353-3376
Mailing Address - Fax:561-404-1170
Practice Address - Street 1:7050 W PALMETTO PARK RD
Practice Address - Street 2:SUITE 30
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3426
Practice Address - Country:US
Practice Address - Phone:561-353-3376
Practice Address - Fax:561-404-1170
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108749207N00000X
NY245993207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFH461ZMedicare PIN