Provider Demographics
NPI:1780917229
Name:DEANGELO, SAMUEL EMILIO
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:EMILIO
Last Name:DEANGELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5012
Mailing Address - Country:US
Mailing Address - Phone:610-703-5628
Mailing Address - Fax:
Practice Address - Street 1:513 10TH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5012
Practice Address - Country:US
Practice Address - Phone:610-703-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies