Provider Demographics
NPI:1922406875
Name:ANGELS MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:ANGELS MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P. WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-383-0400
Mailing Address - Street 1:1524 ATWOOD AVE
Mailing Address - Street 2:SUITE 327
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3228
Mailing Address - Country:US
Mailing Address - Phone:401-383-0400
Mailing Address - Fax:401-383-0410
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:SUITE 327
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-383-0400
Practice Address - Fax:401-383-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI09384207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty