Provider Demographics
NPI:1801810858
Name:DOBRZYNSKI, ANGELIA H (PA)
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:H
Last Name:DOBRZYNSKI
Suffix:
Gender:F
Credentials:PA
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 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:1775 ALYSHEBA WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9023
Practice Address - Country:US
Practice Address - Phone:859-260-4530
Practice Address - Fax:859-260-4530
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA401363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95005666Medicaid
KY95005666Medicaid
IN0990014Medicare ID - Type Unspecified