Provider Demographics
NPI:1477849560
Name:BYRON, ANGELA DAWN (DO)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DAWN
Last Name:BYRON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DAWN
Other - Last Name:THACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1046 SEACOVE CIR
Mailing Address - Street 2:APT D
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-9163
Mailing Address - Country:US
Mailing Address - Phone:859-806-3379
Mailing Address - Fax:
Practice Address - Street 1:204 COOK RD
Practice Address - Street 2:SUITE 400
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9600
Practice Address - Country:US
Practice Address - Phone:513-228-7800
Practice Address - Fax:513-725-2231
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0116852084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry