Provider Demographics
NPI:1861471757
Name:ANGELOV, ANGEL STOYANOV (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:STOYANOV
Last Name:ANGELOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S. BRYN MAWR AVE
Mailing Address - Street 2:PSYCHIATRIC UNIT
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3121
Mailing Address - Country:US
Mailing Address - Phone:484-337-4286
Mailing Address - Fax:484-337-4293
Practice Address - Street 1:130 S. BRYN MAWR AVE
Practice Address - Street 2:PSYCHIATRIC UNIT
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3121
Practice Address - Country:US
Practice Address - Phone:484-337-4286
Practice Address - Fax:484-337-4293
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4218262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019636770004Medicaid
PA0019636770004Medicaid
PA232359401OtherMLHC TIN