Healthcare Provider Details

I. General information

NPI: 1891706818
Provider Name (Legal Business Name): ROBERT NICHOLAS ANGELO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 BELMONT AVE
YOUNGSTOWN OH
44505-2401
US

IV. Provider business mailing address

3050 HALSEY DR NE
WARREN OH
44483-5612
US

V. Phone/Fax

Practice location:
  • Phone: 330-740-9200
  • Fax: 330-740-9231
Mailing address:
  • Phone: 330-740-9200
  • Fax: 330-740-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: