Healthcare Provider Details

I. General information

NPI: 1568729267
Provider Name (Legal Business Name): ANGELA MARIE PENDLETON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 RITTER DR
DANIELS WV
25832-9371
US

IV. Provider business mailing address

252 RURAL ACRES DR
BECKLEY WV
25801-3503
US

V. Phone/Fax

Practice location:
  • Phone: 304-763-4326
  • Fax:
Mailing address:
  • Phone: 304-252-8555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2771
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: