Provider Demographics
NPI:1598727018
Name:ALICEA, ANGEL EDGARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:EDGARDO
Last Name:ALICEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-5764
Mailing Address - Country:US
Mailing Address - Phone:302-629-9099
Mailing Address - Fax:302-629-9499
Practice Address - Street 1:200 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-5764
Practice Address - Country:US
Practice Address - Phone:302-629-9099
Practice Address - Fax:302-629-9499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004542207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000631001Medicaid
E69605Medicare UPIN