MEDICARE: DR. VINCENT PALERACIO ANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	D0015068	MD
2	2083X0100X	Occupational Medicine Physician	D0015068	MD

General Provider Information

NPI Number	:	1043457195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT PALERACIO ANG M.D.

Provider Business Mailing Address
First Line	:	112 ASHTON OAKS CT
Second Line	:
City	:	ASHTON
State	:	MD
Zip	:	20861-9711
Country	:	US
Telephone Number	:	301-774-1099
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 ASHTON OAKS CT
Second Line	:
City	:	ASHTON
State	:	MD
Zip	:	20861-9711
Country	:	US
Telephone Number	:	301-774-1099
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	01/12/2009

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