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NPI Code Detail

MEDICARE: GREGG D'ANGELO PHD

MEDICARE: GREGG D'ANGELO PHD
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
1103G00000XClinical Neuropsychologist24947TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
124947OTHERTXTEXAS LICENSE
286850AOTHERTXBLUE CROSS ID W/IN GROUP
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598776593
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGG D'ANGELO PHD
Provider Business Mailing Address
First Line : 11882 GREENVILLE AVE STE 121
Second Line :
City : DALLAS
State : TX
Zip : 75243-3567
Country : US
Telephone Number : 972-424-9212
Fax Number : 972-509-1450
Provider Business Practice Location Address
First Line : 11882 GREENVILLE AVE STE 121
Second Line :
City : DALLAS
State : TX
Zip : 75243-3567
Country : US
Telephone Number : 972-424-9212
Fax Number : 972-509-1450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 09/17/2014

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Directions to “ GREGG D'ANGELO PHD” Practice Location

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