Provider Demographics
NPI:1144415506
Name:ANGELOV, ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ANGELOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COMMONWEALTH TER
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2616
Mailing Address - Country:US
Mailing Address - Phone:781-392-4464
Mailing Address - Fax:781-990-2220
Practice Address - Street 1:2 1ST AVE STE 215
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4962
Practice Address - Country:US
Practice Address - Phone:781-593-8775
Practice Address - Fax:781-990-2220
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ16880OtherBLUE CROSS BLUE SHIELD
MA150941OtherTUFTS
MA3156826Medicaid
MA71280OtherHARVARD PILGRIM HEALTH
MA71280OtherHARVARD PILGRIM HEALTH