Provider Demographics
NPI:1376507871
Name:MINUTILLO, ANGELO L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:L
Last Name:MINUTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:849 COOPER ST
Practice Address - Street 2:
Practice Address - City:DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-2571
Practice Address - Country:US
Practice Address - Phone:856-848-6346
Practice Address - Fax:856-848-5734
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2011-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04761200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
077356Medicare Oscar/Certification