Provider Demographics
NPI:1881673275
Name:DIMARCANGELO, MICHAEL C JR (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:DIMARCANGELO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 HIALEAH DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5706
Mailing Address - Country:US
Mailing Address - Phone:609-779-7386
Mailing Address - Fax:
Practice Address - Street 1:19 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052-2411
Practice Address - Country:US
Practice Address - Phone:856-779-7386
Practice Address - Fax:856-779-7563
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB04884500207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC58130Medicare UPIN