Provider Demographics
NPI:1568613909
Name:PANSERA, ANGELA MARYANN (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARYANN
Last Name:PANSERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8926 WOODYARD RD
Mailing Address - Street 2:STE 301
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4220
Mailing Address - Country:US
Mailing Address - Phone:301-856-6718
Mailing Address - Fax:301-856-6722
Practice Address - Street 1:7801 OLD BRANCH AVE
Practice Address - Street 2:STE 300
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1608
Practice Address - Country:US
Practice Address - Phone:301-856-6718
Practice Address - Fax:301-856-6722
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-00087252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568613909Medicaid
MD447817700Medicaid
MD257157ZBQ0Medicare PIN
VA1568613909Medicaid
DC256668ZCMEMedicare PIN