Provider Demographics
NPI:1154858280
Name:PRONGER, ANGELA MARIE (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:PRONGER
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4494 PALMER RD N
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:240-656-0833
Mailing Address - Fax:619-532-5507
Practice Address - Street 1:NAVAL MEDICAL CTR 34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-0001
Practice Address - Country:US
Practice Address - Phone:619-532-5998
Practice Address - Fax:619-532-5507
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01080839A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000OtherMEDICARE MILITARY PHYSICIANS