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General NPI Number Information
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NPI Number | 1538352877
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Entity Type | Organization
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Legal Business Name | ANGEL PURDY, M.D., P.A.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 3635 OLD COURT RD SUITE 412
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City | PIKESVILLE
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State | MD
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Zip | 21208-3915
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Country | US
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Telephone | 410-602-3656
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Fax | 410-602-3658
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Provider Business Mailing Address
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Address Line | 3635 OLD COURT RD SUITE 412
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City | PIKESVILLE
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State | MD
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Zip | 21208-3915
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Country | US
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Telephone | 410-602-3656
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Fax | 410-602-3658
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGEL MARLO PURDY
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Credential | M.D.
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Telephone | 410-602-3656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | D0061231
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License Number State | MD
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