Provider Demographics
NPI:1679648497
Name:DELLA PIETRA, ANGELO ANTHONY (MD, DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:ANTHONY
Last Name:DELLA PIETRA
Suffix:
Gender:M
Credentials:MD, DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3 GRIST MILL LN
Mailing Address - Street 2:
Mailing Address - City:STANFORDVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12581-5823
Mailing Address - Country:US
Mailing Address - Phone:845-454-4324
Mailing Address - Fax:845-454-4295
Practice Address - Street 1:3 GRIST MILL LN
Practice Address - Street 2:
Practice Address - City:STANFORDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12581-5823
Practice Address - Country:US
Practice Address - Phone:845-454-4324
Practice Address - Fax:845-454-4295
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY197353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01590692Medicaid
NY01590692Medicaid
NYG16498Medicare UPIN