Provider Demographics
NPI:1922095520
Name:TELLIS, ANGELO (MD)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:TELLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 NEUSE BLVD. SUITE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4317
Mailing Address - Country:US
Mailing Address - Phone:252-636-0300
Mailing Address - Fax:252-636-0335
Practice Address - Street 1:2111 NEUSE BLVD. SUITE J
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4317
Practice Address - Country:US
Practice Address - Phone:252-636-0300
Practice Address - Fax:252-636-0335
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99010502081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH02385Medicare UPIN