Provider Demographics
NPI:1669654463
Name:URBAN, ANGELA P (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:P
Last Name:URBAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:5 HEDGEAPPLE DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:PA
Practice Address - Zip Code:17004-8678
Practice Address - Country:US
Practice Address - Phone:833-552-1852
Practice Address - Fax:570-214-1524
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMAO55803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMAO55803OtherPENNSYLVANIA PHYSICIAN ASSISTANT LICENSE
PAMAO55803OtherPENNSYLVANIA PHYSICIAN ASSISTANT LICENSE
IL085003144OtherLICENSE NUMBER