Healthcare Provider Details

I. General information

NPI: 1568613909
Provider Name (Legal Business Name): ANGELA MARYANN PANSERA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 OLD BRANCH AVE STE 300
CLINTON MD
20735-1608
US

IV. Provider business mailing address

8926 WOODYARD RD STE 301
CLINTON MD
20735-4220
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-6718
  • Fax: 301-856-6722
Mailing address:
  • Phone: 301-856-6718
  • Fax: 301-856-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC2-0008725
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: