Provider Demographics
NPI:1225266208
Name:MILLS, ANGELA M (DO)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:DO
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 763
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0763
Mailing Address - Country:US
Mailing Address - Phone:800-541-4009
Mailing Address - Fax:
Practice Address - Street 1:134 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-9785
Practice Address - Country:US
Practice Address - Phone:304-884-7880
Practice Address - Fax:304-884-8902
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810023430Medicaid