Healthcare Provider Details

I. General information

NPI: 1346234432
Provider Name (Legal Business Name): ALAN HOWARD ANGELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ROUTE 146 BLDG B
CLIFTON PARK NY
12065-3885
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1789
  • Fax:
Mailing address:
  • Phone: 518-525-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number179027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: