Provider Demographics
NPI:1700980836
Name:MILLORA, ANGEL B (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:B
Last Name:MILLORA
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 249
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0249
Mailing Address - Country:US
Mailing Address - Phone:518-689-3588
Mailing Address - Fax:518-689-2396
Practice Address - Street 1:1882 NEW SCOTLAND RD
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-3627
Practice Address - Country:US
Practice Address - Phone:518-689-3588
Practice Address - Fax:518-689-3597
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00361064Medicaid
D02010Medicare UPIN
NY56588IMedicare ID - Type Unspecified