Provider Demographics
NPI:1326120734
Name:EARHART, ANGELA DAWN (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:EARHART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:IANCULOVILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 KINGWOOD MEDICAL DRIVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4412
Mailing Address - Country:US
Mailing Address - Phone:832-978-5611
Mailing Address - Fax:281-205-0204
Practice Address - Street 1:350 KINGWOOD MEDICAL DRIVE
Practice Address - Street 2:SUITE 215
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4412
Practice Address - Country:US
Practice Address - Phone:832-978-5611
Practice Address - Fax:281-205-0204
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4767207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ693OtherBLUE CROSS BLUE SHIELD
TX185571006Medicaid
TX185571002Medicaid