Provider Demographics
NPI:1356351803
Name:ANGERMAN, DOUGLAS R (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:ANGERMAN
Suffix:
Gender:M
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 74006
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44191-0001
Mailing Address - Country:US
Mailing Address - Phone:216-383-6776
Mailing Address - Fax:216-383-6475
Practice Address - Street 1:167 W MAIN RD
Practice Address - Street 2:SUITE F
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-2057
Practice Address - Country:US
Practice Address - Phone:440-599-7466
Practice Address - Fax:440-593-6498
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35032500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0248959Medicaid
A14792Medicare UPIN
OH0248959Medicaid