Provider Demographics
NPI:1427010651
Name:D'ANGELO, ANTHONY JR (DO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:D'ANGELO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 LILLIE AVE
Mailing Address - Street 2:SUITE 7 8
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4400
Mailing Address - Country:US
Mailing Address - Phone:563-386-9124
Mailing Address - Fax:563-445-0486
Practice Address - Street 1:3906 LILLIE AVE
Practice Address - Street 2:SUITE 7 8
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4400
Practice Address - Country:US
Practice Address - Phone:563-386-9124
Practice Address - Fax:563-445-0486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01952207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41644OtherBLUE CROSS BLUE SHIELD
IA1197749Medicaid
IA41644OtherBLUE CROSS BLUE SHIELD
IA41644Medicare ID - Type Unspecified