Healthcare Provider Details

I. General information

NPI: 1912124454
Provider Name (Legal Business Name): ANGELA TABER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA PLETTE MD

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE.
PROVIDENCE RI
02906
US

IV. Provider business mailing address

P.O. BOX 3915
BOSTON MA
02241-3915
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-2920
  • Fax: 401-793-2859
Mailing address:
  • Phone: 401-793-4634
  • Fax: 401-793-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD12200
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12200
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD12200
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number80010
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: