Provider Demographics
NPI:1134479645
Name:FORD, ANGELA B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:B
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANGELA
Other - Middle Name:B
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7901 MCCREEDY DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9695
Mailing Address - Country:US
Mailing Address - Phone:336-558-3245
Mailing Address - Fax:
Practice Address - Street 1:7901 MCCREEDY DR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9695
Practice Address - Country:US
Practice Address - Phone:336-558-3245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2014-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102891363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC579AMedicare PIN