Provider Demographics
NPI:1477509354
Name:HOLLIS, ANGELA L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1938
Mailing Address - Country:US
Mailing Address - Phone:724-656-4320
Mailing Address - Fax:724-656-4324
Practice Address - Street 1:2411 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1938
Practice Address - Country:US
Practice Address - Phone:724-656-4320
Practice Address - Fax:724-656-4324
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428318207Q00000X
SC28679207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000269161OtherUNISON
SC20087156OtherSELECT HEALTH
SC216414OtherMEDCOST
SC286791Medicaid
SC5164353OtherCIGNA
SC7195863OtherAENTA
SC063OtherBCBS
SCAA14998552OtherMEDICARE PTAN
SC18500OtherEVOLUTIONS
SC062OtherBCBS
SC216414OtherMEDCOST