Provider Demographics
NPI:1619034691
Name:BARROSO, ANGELA RICHARDSON (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RICHARDSON
Last Name:BARROSO
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31209
Mailing Address - Country:US
Mailing Address - Phone:478-474-5252
Mailing Address - Fax:478-474-4244
Practice Address - Street 1:4035 ELNORA DRIVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-474-5252
Practice Address - Fax:478-474-4244
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics