MEDICARE: RANDY LAMAR ANGELL M.D.

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
1	207Q00000X	Family Medicine Physician	D0069326	MD
2	207Q00000X	Family Medicine Physician	45229	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407066624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDY LAMAR ANGELL M.D.

Provider Business Mailing Address
First Line	:	8507 LIBERTY RD
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-4833
Country	:	US
Telephone Number	:	410-496-6441
Fax Number	:	410-496-6448

Provider Business Practice Location Address
First Line	:	8507 LIBERTY RD
Second Line	:
City	:	RANDALLSTOWN
State	:	MD
Zip	:	21133-4833
Country	:	US
Telephone Number	:	410-496-6441
Fax Number	:	410-496-6448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/07/2023

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