Provider Demographics
NPI:1174852362
Name:ANGELO, DEBRA GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:GAIL
Last Name:ANGELO
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 645743
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5743
Mailing Address - Country:US
Mailing Address - Phone:855-689-5105
Mailing Address - Fax:888-507-9833
Practice Address - Street 1:9332 STATE ROAD 54 STE 302
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1810
Practice Address - Country:US
Practice Address - Phone:727-834-4450
Practice Address - Fax:727-816-2151
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-094510207R00000X
FLME1080382083P0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110400300Medicaid