Provider Demographics
NPI:1467445072
Name:YERDON MCLEOD, ANGELA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:YERDON MCLEOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:CRFHC
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-228-7200
Mailing Address - Fax:603-228-7307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:CRFHC
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-228-7307
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401008207Q00000X
NH12926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH386577OtherMVP HEALTHCARE
NHH80271OtherHARVARD PILGRIM HEALTHCAR
NH04YP08848NH01OtherANTHEM
NH1102781OtherAETNA
NH222594672OtherPRIVATE HEALTHCARE
NH30224015Medicaid
NH0152165OtherCIGNA
NH222594672OtherGREATWEST HEALTHCARE
NH222594672OtherUNITED HEALTHCARE
NH222594672OtherTRICARE
NH222594672OtherUNITED HEALTHCARE
NCH80271Medicare UPIN