Provider Demographics
NPI:1972552735
Name:EMMONS BRULE', ANGELA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LOUISE
Last Name:EMMONS BRULE'
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:EMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20717-1440
Mailing Address - Country:US
Mailing Address - Phone:301-218-0625
Mailing Address - Fax:301-218-0634
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1141
Practice Address - Fax:202-865-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD16179207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021566500Medicaid
DCCS8802239OtherCONTROLLED SUBSTANCE
DCCS8802239OtherCONTROLLED SUBSTANCE
DCBE3107631OtherDEA