Provider Demographics
NPI:1598150070
Name:HATEF, ANGEL LONG (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LONG
Last Name:HATEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:HATEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-7289
Mailing Address - Country:US
Mailing Address - Phone:740-348-4710
Mailing Address - Fax:
Practice Address - Street 1:1320 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1822
Practice Address - Country:US
Practice Address - Phone:740-348-4710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1312422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology