Provider Demographics
NPI:1972745602
Name:PRESCOTT, ANGELA TE-FANG (MD)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:TE-FANG
Last Name:PRESCOTT
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 1:2507 BUSH RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5885
Mailing Address - Country:US
Mailing Address - Phone:502-589-8000
Mailing Address - Fax:502-589-8001
Practice Address - Street 1:2507 BUSH RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5885
Practice Address - Country:US
Practice Address - Phone:502-589-8000
Practice Address - Fax:502-589-8001
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY55035208600000X, 2086S0122X
PAMT215390208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery