Healthcare Provider Details

I. General information

NPI: 1245238328
Provider Name (Legal Business Name): ANGELA DUMITRACHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 MACK AVE STE B
FREDERICK MD
21703-3303
US

IV. Provider business mailing address

13121 BROOK LANE
HAGERSTOWN MD
21742-1514
US

V. Phone/Fax

Practice location:
  • Phone: 301-733-0331
  • Fax: 301-733-4038
Mailing address:
  • Phone: 301-733-0331
  • Fax: 301-733-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21360
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: