Provider Demographics
NPI:1922056530
Name:DEANGELO, JAMES N (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:DEANGELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORT COUCH RD
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-1041
Mailing Address - Country:US
Mailing Address - Phone:412-833-8811
Mailing Address - Fax:412-833-7011
Practice Address - Street 1:180 FORT COUCH RD
Practice Address - Street 2:SUITE 375
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1041
Practice Address - Country:US
Practice Address - Phone:412-833-8811
Practice Address - Fax:412-833-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007667L207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA901225Medicare ID - Type Unspecified
PAG48323Medicare UPIN