Provider Demographics
NPI:1083689301
Name:DEANGELO, DEBRA A (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:DEANGELO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:A
Other - Last Name:DEANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABS3705374207L00000X
PAOS088200L207LP2900X
PAOS008200L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1586384Medicaid
PA883497 SF0Medicare PIN
G30398Medicare UPIN