Healthcare Provider Details

I. General information

NPI: 1376526608
Provider Name (Legal Business Name): ANGELA M GIZA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: ANGELA M OSTROUT

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 LEOMINSTER RD
STERLING MA
01564-2114
US

IV. Provider business mailing address

PO BOX 586
SOUTHBOROUGH MA
01772-0586
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-7774
  • Fax: 978-422-9089
Mailing address:
  • Phone: 978-422-7774
  • Fax: 978-422-9089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number195569
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: