Healthcare Provider Details

I. General information

NPI: 1295112977
Provider Name (Legal Business Name): NICHOLAS WILLIAM DEANGELIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 140 VILLAGE ROAD SUITE 1
WESTMINSTER MD
21157-6196
US

IV. Provider business mailing address

332 140 VILLAGE ROAD SUITE 1
WESTMINSTER MD
21157-6196
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-9680
  • Fax: 410-386-0876
Mailing address:
  • Phone: 480-529-6034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0082683
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: