Provider Demographics
NPI:1295798999
Name:ANGUELOVA, DORA L (MD)
Entity type:Individual
Prefix:DR
First Name:DORA
Middle Name:L
Last Name:ANGUELOVA
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:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-0749
Mailing Address - Country:US
Mailing Address - Phone:843-357-6734
Mailing Address - Fax:843-357-6770
Practice Address - Street 1:4914 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5040
Practice Address - Country:US
Practice Address - Phone:843-357-6734
Practice Address - Fax:843-357-6770
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3580Medicaid
SC7713Medicare ID - Type Unspecified
SCH47041Medicare UPIN