Healthcare Provider Details

I. General information

NPI: 1942208251
Provider Name (Legal Business Name): EDGARDO C ANGELES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W GROVE ST
MIDDLEBORO MA
02346-1458
US

IV. Provider business mailing address

2 CORNERSTONE DR
NORTH EASTON MA
02356-2740
US

V. Phone/Fax

Practice location:
  • Phone: 508-923-3427
  • Fax: 508-923-3428
Mailing address:
  • Phone: 508-238-5510
  • Fax: 508-238-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76522
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: