Healthcare Provider Details

I. General information

NPI: 1245233451
Provider Name (Legal Business Name): DORALINA L. ANGHELESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PLACE., MS 0515 ST. JUDE CHILDREN'S RESEARCH HOSPITAL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PLACE., MS 0515 ST. JUDE CHILDREN'S RESEARCH HOSPITAL
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3006
  • Fax: 901-595-3842
Mailing address:
  • Phone: 901-595-3006
  • Fax: 901-595-3842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number31175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: