Healthcare Provider Details

I. General information

NPI: 1649241415
Provider Name (Legal Business Name): ROGER MICHAEL ANGELELLI PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LEWIS RUN RD SUITE 117
PITTSBURGH PA
15122-3056
US

IV. Provider business mailing address

500 LEWIS RUN RD SUITE 117
PITTSBURGH PA
15122-3056
US

V. Phone/Fax

Practice location:
  • Phone: 412-466-5550
  • Fax: 412-466-8741
Mailing address:
  • Phone: 412-466-5550
  • Fax: 412-466-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000196L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: