Provider Demographics
NPI:1710252671
Name:ANDERSON, ANGELA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ANN
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 412047
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241
Mailing Address - Country:US
Mailing Address - Phone:301-790-9044
Mailing Address - Fax:301-790-9096
Practice Address - Street 1:13620 CRAYTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2685
Practice Address - Country:US
Practice Address - Phone:240-313-9890
Practice Address - Fax:240-313-9891
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004702363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical