Provider Demographics
NPI:1194855171
Name:GILBERT, ANGELA B (MPH, RD, CDE)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:B
Last Name:GILBERT
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2862
Mailing Address - Country:US
Mailing Address - Phone:919-489-4267
Mailing Address - Fax:
Practice Address - Street 1:2614 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2862
Practice Address - Country:US
Practice Address - Phone:919-489-4267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001573133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1436COtherBLUE CROSS BLUE SHIELD