Provider Demographics
NPI:1861489528
Name:PETTENATI, ANGELA MARIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIS
Last Name:PETTENATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-856-9699
Mailing Address - Fax:330-856-9935
Practice Address - Street 1:5000 E MARKET ST STE 30
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2259
Practice Address - Country:US
Practice Address - Phone:330-856-9699
Practice Address - Fax:330-856-9935
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082903208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics