Provider Demographics
NPI:1649773250
Name:BOOKER, ANGELIA PEGRAM
Entity Type:Individual
Prefix:MRS
First Name:ANGELIA
Middle Name:PEGRAM
Last Name:BOOKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23860-6606
Mailing Address - Country:US
Mailing Address - Phone:804-712-4681
Mailing Address - Fax:
Practice Address - Street 1:1623 BEXLEY DR
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-6606
Practice Address - Country:US
Practice Address - Phone:804-712-4681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2534343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)