Provider Demographics
NPI:1508898743
Name:BECK, ANGELA NIEDBALA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:NIEDBALA
Last Name:BECK
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 1:4700 WATERS AVE
Mailing Address - Street 2:2ND FLOOR, GA EAR BLDG.
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-350-7412
Mailing Address - Fax:912-350-7297
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:2ND FLOOR, GA EAR BLDG.
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-7412
Practice Address - Fax:912-350-7297
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052476208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00431539OtherRAILROAD MEDICARE
GA10063434OtherAMERIGROUP
GA349714OtherWELLCARE
SCG52476Medicaid
GA992287413AMedicaid
GAP00246459OtherRAILROAD MEDICARE
GA10063434OtherAMERIGROUP
GA349714OtherWELLCARE
SCG52476Medicaid