Provider Demographics
NPI:1073689410
Name:FOREMAN, ANGELA IMMEDIATO
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:IMMEDIATO
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIE
Other - Last Name:IMMEDIATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 WEST HILLSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363
Mailing Address - Country:US
Mailing Address - Phone:610-996-9323
Mailing Address - Fax:
Practice Address - Street 1:179 WEST CHESTNUT HILL ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2294
Practice Address - Country:US
Practice Address - Phone:302-731-0858
Practice Address - Fax:302-731-0027
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant