Provider Demographics
NPI:1982678678
Name:VANGELDER, HUGH MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:MAURICE
Last Name:VANGELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUGH
Other - Middle Name:M
Other - Last Name:VAN GELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3310 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5250
Mailing Address - Country:US
Mailing Address - Phone:352-343-1216
Mailing Address - Fax:352-343-1582
Practice Address - Street 1:3310 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5250
Practice Address - Country:US
Practice Address - Phone:352-343-1216
Practice Address - Fax:352-343-1582
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59091208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1353524OtherUNITED
FL14986OtherBCBS
FL1040683OtherCIGNA
FL240489OtherAVMED
FL134223953OtherHUMANA
FL17791OtherWELLCARE
FL3306362OtherAETNA
FL17791OtherSTAYWELL
FL134223953OtherHUMANA
FL370217100Medicaid
FL17791OtherSTAYWELL
FL14986YMedicare PIN