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NPI Code Detail

MEDICARE: DR. CHRISTOPHER PAUL DEANGELIS MD

MEDICARE: DR. CHRISTOPHER PAUL DEANGELIS MD
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
1208000000XPediatrics Physician154686MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J18691OTHERMABCBS MA

General Provider Information

NPI Number : 1376534388
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER PAUL DEANGELIS MD
Provider Business Mailing Address
First Line : 300 BROADWAY
Second Line : SOMERVILLE PEDIATRICS
City : SOMERVILLE
State : MA
Zip : 02145-2935
Country : US
Telephone Number : 617-284-7000
Fax Number :
Provider Business Practice Location Address
First Line : 300 BROADWAY
Second Line : SOMERVILLE PEDIATRICS
City : SOMERVILLE
State : MA
Zip : 02145-2935
Country : US
Telephone Number : 617-284-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 12/02/2011

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