Healthcare Provider Details

I. General information

NPI: 1609851864
Provider Name (Legal Business Name): HENRY D'ANGELO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORFOLK ST
WALPOLE MA
02081-1703
US

IV. Provider business mailing address

99 HARTFORD ST
MEDFIELD MA
02052-1402
US

V. Phone/Fax

Practice location:
  • Phone: 508-660-1200
  • Fax:
Mailing address:
  • Phone: 508-359-2810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78579
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: