Provider Demographics
NPI:1417198870
Name:ANGA, ALTAF GULAMHUSAIN (MD)
Entity Type:Individual
Prefix:
First Name:ALTAF
Middle Name:GULAMHUSAIN
Last Name:ANGA
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 1:7000 4TH ST N STE A
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5903
Mailing Address - Country:US
Mailing Address - Phone:727-526-3627
Mailing Address - Fax:
Practice Address - Street 1:7000 4TH ST N STE A
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5903
Practice Address - Country:US
Practice Address - Phone:727-526-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436462207Q00000X, 208M00000X
FLME118363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037276OtherMLHC AA #
PAMD436462OtherPA MEDICAL LICENSE
PA23-2359401OtherMLHC TIN