Healthcare Provider Details

I. General information

NPI: 1194911909
Provider Name (Legal Business Name): ANGELA A D'URSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2007
Last Update Date: 09/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MORGAN DALE CT
MORGANTOWN PA
19543-8849
US

IV. Provider business mailing address

5 MORGAN DALE CT
MORGANTOWN PA
19543-8849
US

V. Phone/Fax

Practice location:
  • Phone: 610-913-1303
  • Fax:
Mailing address:
  • Phone: 610-913-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD057762L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: