Healthcare Provider Details

I. General information

NPI: 1255334462
Provider Name (Legal Business Name): ANGELA K AILES-FRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SCIOTO TRL SUITE 100
PORTSMOUTH OH
45662-2845
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-353-6390
  • Fax: 740-353-6290
Mailing address:
  • Phone: 606-408-5044
  • Fax: 606-408-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35071655
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41511
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: