Provider Demographics
NPI:1952747974
Name:D'ANGELO, ALEXANDRA CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:CHRISTINE
Last Name:D'ANGELO
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:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-0798
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4855 CAMP RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-2600
Practice Address - Country:US
Practice Address - Phone:716-646-1084
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04503013Medicaid
NYJ400319262Medicare PIN