Provider Demographics
NPI:1174653604
Name:ANGELES, MARIA LOURDES S (MD)
Entity Type:Individual
Prefix:
First Name:MARIA LOURDES
Middle Name:S
Last Name:ANGELES
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 1:11 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3103
Mailing Address - Country:US
Mailing Address - Phone:508-475-3220
Mailing Address - Fax:
Practice Address - Street 1:UMASS CORRECTIONAL HEALTH PROGRAM
Practice Address - Street 2:ONE RESEARCH DRIVE
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-475-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine