Provider Demographics
NPI:1114976610
Name:WO, ANGELA Y (MD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:Y
Last Name:WO
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:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-232-1617
Mailing Address - Fax:505-226-7729
Practice Address - Street 1:2901 TRANSPORT ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4382
Practice Address - Country:US
Practice Address - Phone:505-262-7097
Practice Address - Fax:505-262-7636
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07980200207N00000X
NMMD2012-0043207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM26257301Medicaid
NJ44739OtherUNIVERSITY HEALTH PLANS
NJ315174OtherAMERICAID/AMERIGROUP
NJ9080214OtherAETNA PPO
NJP3930429OtherOXFORD
NJ0164639OtherGHI PPO
NJ150839C2HMedicare PIN
NJ9080214OtherAETNA PPO