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NPI Code Detail

MEDICARE: JOHN CLINTON ANGELOZZI M.ED.

MEDICARE: JOHN CLINTON ANGELOZZI M.ED.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1366793267
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN CLINTON ANGELOZZI M.ED.
Provider Business Mailing Address
First Line : 85 MONUMENT NECK RD
Second Line :
City : BOURNE
State : MA
Zip : 02532-4111
Country : US
Telephone Number : 603-833-1185
Fax Number :
Provider Business Practice Location Address
First Line : 134 MAIN ST
Second Line :
City : BUZZARDS BAY
State : MA
Zip : 02532-3221
Country : US
Telephone Number : 917-698-3194
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2012
Last Update Date : 10/02/2012

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