Healthcare Provider Details

I. General information

NPI: 1902878275
Provider Name (Legal Business Name): ANGELA ANG-ALHADEFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 HIGHLAND AVE SE
ROANOKE VA
24013-2254
US

IV. Provider business mailing address

1555 STRAWBERRY MOUNTAIN DR
ROANOKE VA
24018-7686
US

V. Phone/Fax

Practice location:
  • Phone: 540-985-9835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101-233892
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101-233892
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: