Provider Demographics
NPI:1861463036
Name:DEANGELIS, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DEANGELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7114 RIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHI
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3250
Mailing Address - Country:US
Mailing Address - Phone:215-298-5000
Mailing Address - Fax:215-298-5001
Practice Address - Street 1:7114 RIDGE AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHI
Practice Address - State:PA
Practice Address - Zip Code:19128-3250
Practice Address - Country:US
Practice Address - Phone:215-298-5000
Practice Address - Fax:215-298-5001
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039665E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA564065HK1Medicare UPIN
PA001179421Medicaid
PA440771OtherMLHC MEDICARE AA #
PA23-2359401OtherMLHC TIN