Provider Demographics
NPI:1013902543
Name:PENCE, ANGELA G (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:PENCE
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 1:9998 CROSSPOINT BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10461912085R0202X
IN01046191A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00032459OtherRR MEDICARE PIN
P00032639OtherRR MEDICARE PIN
IN200197350AMedicaid
IN300131511OtherRAILROAD MEDICARE
P00032678OtherRR MEDICARE PIN
P00032681OtherRR MEDICARE PIN
P00257531OtherRR MEDICARE PIN
P00032507OtherRR MEDICARE PIN
P00032969OtherRR MEDICARE PIN
P00033122OtherRR MEDICARE PIN
IN000000219647OtherANTHEM
P00032457OtherRR MEDICARE PIN
P00032458OtherRR MEDICARE PIN
P00032640OtherRR MEDICARE PIN
P00032679OtherRR MEDICARE PIN
P00032756OtherRR MEDICARE PIN
P00032459OtherRR MEDICARE PIN
IN222750RMedicare PIN
152410LMedicare PIN
P00032507OtherRR MEDICARE PIN
INF33881Medicare UPIN