Provider Demographics
NPI:1851559207
Name:MARLA C ANGERMEIER, MD, PC
Entity Type:Organization
Organization Name:MARLA C ANGERMEIER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-273-9310
Mailing Address - Street 1:148 W RIVER ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2615
Mailing Address - Country:US
Mailing Address - Phone:401-273-9310
Mailing Address - Fax:401-273-1270
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:SUITE 1 B
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2615
Practice Address - Country:US
Practice Address - Phone:401-273-9310
Practice Address - Fax:401-273-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-31
Last Update Date:2008-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6161207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI079000274OtherMEDICARE ID TYPE UNSPECIFIED
070001832OtherRAILROAD MEDICARE
RI2741OtherBLUE CROSS
050423719OtherUNITED HEALTH PLAN
RI900274Medicaid
RI003626OtherBLUE CHIP
RIC57094Medicare UPIN