Provider Demographics
NPI:1255334462
Name:AILES-FRICK, ANGELA K (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:K
Last Name:AILES-FRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-5044
Mailing Address - Fax:606-408-7425
Practice Address - Street 1:2001 SCIOTO TRL
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2845
Practice Address - Country:US
Practice Address - Phone:740-353-6390
Practice Address - Fax:740-353-6290
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071655207Q00000X
KY41511207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056859Medicaid
KY7100019280Medicaid
KY7100019280Medicaid
OH2056859Medicaid
OH4223647Medicare PIN
OHG73056Medicare UPIN