Healthcare Provider Details

I. General information

NPI: 1902054182
Provider Name (Legal Business Name): ANGELA KELLIHER MANCUSO LIPSHUTZ MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ANGELA KELLIHER MANCUSO

II. Dates (important events)

Enumeration Date: 08/30/2008
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 PICCARD DR STE 100
ROCKVILLE MD
20850-4317
US

IV. Provider business mailing address

513 PARNASSUS AVE RM S-455
SAN FRANCISCO CA
94143-0470
US

V. Phone/Fax

Practice location:
  • Phone: 301-921-4400
  • Fax:
Mailing address:
  • Phone: 415-476-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License NumberD0081313
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA112586
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD0081313
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberA112586
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberD0081313
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: