Provider Demographics
NPI:1942306162
Name:MCKINNEY-BOURNE, ANGELIQUE N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:N
Last Name:MCKINNEY-BOURNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 CHAMBERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2545
Mailing Address - Country:US
Mailing Address - Phone:717-564-5400
Mailing Address - Fax:717-564-7859
Practice Address - Street 1:5400 CHAMBERS HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2545
Practice Address - Country:US
Practice Address - Phone:717-564-5400
Practice Address - Fax:717-564-7859
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 418042207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7615520OtherAETNA
PA1148101OtherHEALTH AMERICA
2147159OtherHIGHMARK PPO
PA271003587OtherTRICARE
PA1710213236OtherCD EAST FAMILY HEALTH & WLLNS. CTR. GROUP NPI
PA177237OtherHIGHMARK MEDICARE
PA50091367OtherCAPITAL BLUE CROSS