Provider Demographics
NPI:1982741237
Name:DEANGELO, ALAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JOSEPH
Last Name:DEANGELO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 HOSPITAL ROAD
Mailing Address - Street 2:EISENHOWER ARMY MEDICAL CENTER, ATTN CREDENTIALS
Mailing Address - City:FT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:706-787-2252
Mailing Address - Fax:706-787-6829
Practice Address - Street 1:3623 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6511
Practice Address - Country:US
Practice Address - Phone:706-922-7400
Practice Address - Fax:706-644-0965
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2024-02-15
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Provider Licenses
StateLicense IDTaxonomies
VA0101102540207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD 000Medicare UPIN