Provider Demographics
NPI:1417526187
Name:PICHARDO, ANGELINA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:MARIE
Last Name:PICHARDO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CHAPMAN TER
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-1580
Mailing Address - Country:US
Mailing Address - Phone:732-832-9715
Mailing Address - Fax:
Practice Address - Street 1:215 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2192
Practice Address - Country:US
Practice Address - Phone:609-778-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical