Healthcare Provider Details

I. General information

NPI: 1992105043
Provider Name (Legal Business Name): ANGELI CHOPRA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 BROADWAY SUITE 100
BANGOR ME
04401-3929
US

IV. Provider business mailing address

10600 MONTGOMERY RD STE 200
CINCINNATI OH
45242-4464
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-3550
  • Fax: 207-907-3562
Mailing address:
  • Phone: 207-907-3550
  • Fax: 207-907-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD20140
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.132267
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: