Healthcare Provider Details

I. General information

NPI: 1801459466
Provider Name (Legal Business Name): ANGELA CHOI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 MERCANTILE DR E
FREDERICK MD
21703-7655
US

IV. Provider business mailing address

6550 MERCANTILE DR E
FREDERICK MD
21703-7655
US

V. Phone/Fax

Practice location:
  • Phone: 240-651-5478
  • Fax:
Mailing address:
  • Phone: 240-651-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17287
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberG1-0011470
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: