Provider Demographics
NPI:1407066624
Name:ANGELL, RANDY LAMAR (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:LAMAR
Last Name:ANGELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4833
Mailing Address - Country:US
Mailing Address - Phone:410-496-6441
Mailing Address - Fax:410-496-6448
Practice Address - Street 1:8507 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4833
Practice Address - Country:US
Practice Address - Phone:410-496-6441
Practice Address - Fax:410-496-6448
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0069326207Q00000X
CO45229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47779268Medicaid
CO47779268Medicaid
CO47779268Medicaid