Provider Demographics
NPI:1881648004
Name:ANGELOTTI, MARIETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:
Last Name:ANGELOTTI
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 1:920 LARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1300
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:
Practice Address - Street 1:920 LARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1300
Practice Address - Country:US
Practice Address - Phone:518-465-4771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237285207Q00000X
FLME89252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000412538001OtherBSNENY
NY02845632Medicaid
NY114978OtherGHI HMO
NY070302000057OtherFIDELIS
NY5822D1OtherEMPIRE BLUE CROSS
NY7478863OtherAETNA
NY200398OtherSENIOR WHOLE HEALTH
NY6003782OtherMVP
NY10117679OtherCDPHP
NY070302000057OtherFIDELIS
NY114978OtherGHI HMO