Healthcare Provider Details

I. General information

NPI: 1114599123
Provider Name (Legal Business Name): ESKEDAR AYELE ANGAMO MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

PO BOX 980599
RICHMOND VA
23298-0599
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9350
  • Fax: 804-807-7949
Mailing address:
  • Phone: 804-828-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number0101285304
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101285304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: