MEDICARE: DR. EDGARDO C ANGELES 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	2084P0800X	Psychiatry Physician	76522	MA

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

General Provider Information

NPI Number	:	1942208251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDGARDO C ANGELES M.D.

Provider Business Mailing Address
First Line	:	2 CORNERSTONE DR
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-2740
Country	:	US
Telephone Number	:	508-238-5510
Fax Number	:	508-238-5037

Provider Business Practice Location Address
First Line	:	511 W GROVE ST
Second Line	:
City	:	MIDDLEBORO
State	:	MA
Zip	:	02346-1458
Country	:	US
Telephone Number	:	508-923-3427
Fax Number	:	508-923-3428

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/08/2007

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