Provider Demographics
NPI:1679683619
Name:TALLEY, ANGELA K (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:TALLEY
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 1:2100 FRANKLIN ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3096
Mailing Address - Country:US
Mailing Address - Phone:510-285-9271
Mailing Address - Fax:
Practice Address - Street 1:2100 FRANKLIN ST
Practice Address - Street 2:SUITE 900
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3096
Practice Address - Country:US
Practice Address - Phone:510-285-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043511207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease