Provider Demographics
NPI:1447243134
Name:D'ANGELO, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6821 PALISADES PARK CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7131
Mailing Address - Country:US
Mailing Address - Phone:239-936-8555
Mailing Address - Fax:239-936-5611
Practice Address - Street 1:6821 PALISADES PARK CT
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7131
Practice Address - Country:US
Practice Address - Phone:239-936-8555
Practice Address - Fax:239-936-5611
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0072761208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
82507799OtherCHAMPUS
5786129003OtherCIGNA
2010621OtherAETNA HMO
FL253898900Medicaid
5036640OtherAETNA PPO
FL21078OtherBLUE CROSS BLUE SHIELD
770001672OtherRAILROAD MEDICARE
5786129003OtherCIGNA
21078ZMedicare ID - Type Unspecified