Provider Demographics
NPI:1528022845
Name:DORA ANGUELOVA, MD, PHD, PA
Entity Type:Organization
Organization Name:DORA ANGUELOVA, MD, PHD, PA
Other - Org Name:MAGNOLIA GENERAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGUELOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-357-6734
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-0749
Mailing Address - Country:US
Mailing Address - Phone:843-357-6734
Mailing Address - Fax:843-357-6770
Practice Address - Street 1:4914 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5040
Practice Address - Country:US
Practice Address - Phone:843-357-6734
Practice Address - Fax:843-357-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP 3580Medicaid
SCGP 3580Medicaid