Provider Demographics
NPI:1679570576
Name:ALDRICH, ANGELA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:J
Last Name:ALDRICH
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 1:2730 PIERCE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3764
Mailing Address - Country:US
Mailing Address - Phone:712-277-3141
Mailing Address - Fax:712-277-2645
Practice Address - Street 1:2730 PIERCE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3796
Practice Address - Country:US
Practice Address - Phone:712-277-3141
Practice Address - Fax:712-277-2645
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4578207V00000X
IA33041207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00064861OtherMEDICARE PTAN RAILROAD
IB2715002OtherMEDICARE PTAN
IA1679570576Medicaid
SD1679570576Medicaid
NE1679570576Medicaid
IB2715002OtherMEDICARE PTAN
IA12328Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
SD4997902Medicaid