Provider Demographics
NPI:1821120510
Name:ANGOTT SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ANGOTT SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-222-9500
Mailing Address - Street 1:90 WEST CHESTNUT ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301
Mailing Address - Country:US
Mailing Address - Phone:724-222-9500
Mailing Address - Fax:724-222-9523
Practice Address - Street 1:90 WEST CHESTNUT ST
Practice Address - Street 2:SUITE 525
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-222-9500
Practice Address - Fax:724-222-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010507L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
320540OtherUPMC
PA1948142Medicaid
1604150OtherHIGHMARK
PA078721Medicare ID - Type Unspecified
H81750Medicare UPIN