Provider Demographics
NPI:1851350920
Name:UHLMANN, ANGELIQUE THERESE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:THERESE
Last Name:UHLMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:TERESA
Other - Last Name:UHLMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT - 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8374
Mailing Address - Fax:
Practice Address - Street 1:147 MILK ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4806
Practice Address - Country:US
Practice Address - Phone:617-654-7220
Practice Address - Fax:617-654-7166
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2123037Medicaid
MAA4009201Medicare PIN