Healthcare Provider Details

I. General information

NPI: 1144332115
Provider Name (Legal Business Name): EDGARDO C. ANGELES, MD & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W GROVE ST UNIT 105
MIDDLEBORO MA
02346-1458
US

IV. Provider business mailing address

511 W GROVE ST UNIT 105
MIDDLEBORO MA
02346-1458
US

V. Phone/Fax

Practice location:
  • Phone: 508-923-3427
  • Fax: 508-923-3428
Mailing address:
  • Phone: 508-923-3427
  • Fax: 508-923-3428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8127
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112239
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76522
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number158354
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81052
License Number StateMA
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5288
License Number StateMA

VIII. Authorized Official

Name: EDGARDO CASTRO ANGELES
Title or Position: CLINICAL PSYCHIATRIST
Credential: M.D.
Phone: 508-923-3427