Provider Demographics
NPI:1801051875
Name:COLBERT, ANGELIQUE L (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE
Middle Name:L
Last Name:COLBERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2453
Mailing Address - Country:US
Mailing Address - Phone:609-265-9441
Mailing Address - Fax:609-265-9628
Practice Address - Street 1:36 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060-2453
Practice Address - Country:US
Practice Address - Phone:609-265-9441
Practice Address - Fax:609-265-9628
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB49127207QA0505X
NJMB49127 207OAO505X207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine