Provider Demographics
NPI:1457668519
Name:DANGELO, MAUREEN CLAIRE (PA-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CLAIRE
Last Name:DANGELO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9106
Mailing Address - Country:US
Mailing Address - Phone:330-324-3161
Mailing Address - Fax:
Practice Address - Street 1:6651 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-498-9865
Practice Address - Fax:330-498-4869
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant