Provider Demographics
NPI:1881664217
Name:ANGELO, ALICE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:A
Last Name:ANGELO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:JEFFREY KORFF MD
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-0925
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:264 ELM ST
Practice Address - Street 2:JEFFREY KORFF MD
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-585-0039
Practice Address - Fax:413-586-2148
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA42647207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3057127Medicaid
D83093Medicare UPIN
MAA36948Medicare ID - Type Unspecified