Provider Demographics
NPI:1831198308
Name:DOTY, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DOTY
Suffix:
Gender:F
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9726 SAM FURR RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8218
Practice Address - Country:US
Practice Address - Phone:704-801-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02574207V00000X
OH35072032D207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015787Medicaid
OH2015787Medicaid
OH2015787Medicaid
0827552OtherMEDICARE CLASS
2015787OtherWELFARE CLASS
341931777OtherCARELINK HEALTH PLAN
215531OtherUPMC
DO538570OtherHIGHMARK
G16671Medicare UPIN
341931777ADOtherSUMMA CARE
341931777COtherAULTCARE
160056651Medicare ID - Type UnspecifiedRAILROAD
OH2015787Medicaid
000000179628OtherANTHEM
34193177700OtherWORKERS COMP