Provider Demographics
NPI:1073577722
Name:MERGEL, ANGELA D (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:MERGEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-654-7130
Mailing Address - Fax:617-654-7104
Practice Address - Street 1:147 MILK ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4806
Practice Address - Country:US
Practice Address - Phone:617-654-7130
Practice Address - Fax:617-654-7104
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY68010OtherBLUE CROSS
MA0025563OtherNEIGHBORHOOD HEALTH PLAN
MA908025OtherTUFTS HEALTH PLAN
MAB501027OtherCIGNA
MA0396630Medicaid
MAHV0001OtherHARVARD PILGRIM
MA0025563OtherNEIGHBORHOOD HEALTH PLAN