Provider Demographics
NPI:1821295163
Name:ANANTHARAJ, ANGELA P (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:P
Last Name:ANANTHARAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:STE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-4005
Practice Address - Fax:717-812-2495
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2021-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD431293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA217568OtherUNISON-WMG
2161248OtherMAMSI WMG
PA50070969OtherCAPITAL BLUE CROSS-WMG
PA9322074OtherAETNA
PA109843OtherGEISINGER
PA1563944OtherGATEWAY-WMG
PA1973444OtherHIGHMARK BLUE SHIELD
PA211398OtherJOHNS HOPKINS
PA2852804000OtherAMERIHEALTH 65PA
PA101959345Medicaid
PA20064469OtherAMERIHEALTH MERCY-WMG
MD897873OtherCAREFIRST MD BCBS
PA2852804000OtherAMERIHEALTH 65PA