Healthcare Provider Details

I. General information

NPI: 1922736776
Provider Name (Legal Business Name): BRIDGET ANGONO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

658 HARRY S TRUMAN DR
UPPER MARLBORO MD
20774-2069
US

IV. Provider business mailing address

658 HARRY S TRUMAN DR
UPPER MARLBORO MD
20774-2069
US

V. Phone/Fax

Practice location:
  • Phone: 240-713-1802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200002340
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1401205987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: