Provider Demographics
NPI:1144319682
Name:ANGELO, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST STE 420
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4247
Mailing Address - Country:US
Mailing Address - Phone:215-955-8847
Mailing Address - Fax:
Practice Address - Street 1:925 CHESTNUT ST STE 420
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4247
Practice Address - Country:US
Practice Address - Phone:215-955-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA76041207R00000X
PAMD072017L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1537742OtherAMERIHEALTH PPO/PABS
NJ0009415Medicaid
NJ2222562000OtherAMERIHEALTH/KEYSTONE/IBC
NJ60002302OtherHORIZON NJ HEALTH
NJ3307356OtherAETNA
NJP3130144OtherOXFORD
NJ1537742OtherPA BS/ HIGHMARK
NJ5619054OtherCIGNA
NJ010005552OtherAMERICHOICE
NJ42473OtherUNIVERSITY HEALTH PLAN
NJ60002302OtherHORIZON NJ HEALTH
NJ1537742OtherAMERIHEALTH PPO/PABS