Provider Demographics
NPI:1942208251
Name:ANGELES, EDGARDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:C
Last Name:ANGELES
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 1:2 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2740
Mailing Address - Country:US
Mailing Address - Phone:508-238-5510
Mailing Address - Fax:508-238-5037
Practice Address - Street 1:511 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-923-3427
Practice Address - Fax:508-923-3428
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA765222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3098273Medicaid
RIF36359Medicare UPIN
MA3098273Medicaid
MAJ12928Medicare ID - Type Unspecified