Provider Demographics
NPI:1649241415
Name:ANGELELLI, ROGER MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:MICHAEL
Last Name:ANGELELLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LEWIS RUN RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15122-3056
Mailing Address - Country:US
Mailing Address - Phone:412-466-5550
Mailing Address - Fax:412-466-8741
Practice Address - Street 1:500 LEWIS RUN RD
Practice Address - Street 2:SUITE 117
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15122-3056
Practice Address - Country:US
Practice Address - Phone:412-466-5550
Practice Address - Fax:412-466-8741
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000196L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007049086 0002Medicaid
PA282113OtherIND. PROVIDER BLUE C/S
PAC19732OtherPALMETTO(GBA) RAILROAD M
PA007049086 0002Medicaid