MEDICARE: DR. ANGELIQUE N MCKINNEY-BOURNE 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
1	207Q00000X	Family Medicine Physician	MD 418042	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	177237	OTHER	PA	HIGHMARK MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7615520	OTHER	PA	AETNA
2	1148101	OTHER	PA	HEALTH AMERICA
3	2147159	OTHER		HIGHMARK PPO
4	271003587	OTHER	PA	TRICARE
5	1710213236	OTHER	PA	CD EAST FAMILY HEALTH & WLLNS. CTR. GROUP NPI
7	50091367	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1942306162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELIQUE N MCKINNEY-BOURNE MD

Provider Business Mailing Address
First Line	:	5400 CHAMBERS HILL RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17111-2545
Country	:	US
Telephone Number	:	717-564-5400
Fax Number	:	717-564-7859

Provider Business Practice Location Address
First Line	:	5400 CHAMBERS HILL RD
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17111-2545
Country	:	US
Telephone Number	:	717-564-5400
Fax Number	:	717-564-7859

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	06/16/2022

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Directions to “ DR. ANGELIQUE N MCKINNEY-BOURNE MD” Practice Location

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