Provider Demographics
NPI:1336294487
Name:LAW, ANGELA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:LAW
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 1:17520 WRIGHT ST
Mailing Address - Street 2:STE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-4657
Mailing Address - Country:US
Mailing Address - Phone:402-991-5353
Mailing Address - Fax:402-991-5444
Practice Address - Street 1:17520 WRIGHT ST
Practice Address - Street 2:STE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4657
Practice Address - Country:US
Practice Address - Phone:402-991-5353
Practice Address - Fax:402-991-5444
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99151Medicare UPIN
278999Medicare ID - Type Unspecified