MEDICARE: ANGELO DIFELICE JR.

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	207X00000X	Orthopaedic Surgery Physician	039324	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861492274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELO DIFELICE JR.

Provider Business Mailing Address
First Line	:	1285 HEMBREE RD
Second Line	:	STE 200A
City	:	ROSWELL
State	:	GA
Zip	:	30076
Country	:	US
Telephone Number	:	770-475-2710
Fax Number	:	770-360-0498

Provider Business Practice Location Address
First Line	:	1285 HEMBREE RD
Second Line	:	STE 200A
City	:	ROSWELL
State	:	GA
Zip	:	30076
Country	:	US
Telephone Number	:	770-475-2710
Fax Number	:	770-360-0498

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/22/2016

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Directions to “ ANGELO DIFELICE JR. ” Practice Location

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