Provider Demographics
NPI:1144332115
Name:EDGARDO C. ANGELES, MD & ASSOCIATES, PC
Entity type:Organization
Organization Name:EDGARDO C. ANGELES, MD & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:ANGELES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-923-3427
Mailing Address - Street 1:511 W GROVE ST
Mailing Address - Street 2:UNIT 105
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1458
Mailing Address - Country:US
Mailing Address - Phone:508-923-3427
Mailing Address - Fax:508-923-3428
Practice Address - Street 1:511 W GROVE ST
Practice Address - Street 2:UNIT 105
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1458
Practice Address - Country:US
Practice Address - Phone:508-923-3427
Practice Address - Fax:508-923-3428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5288101YM0800X
MA8127103G00000X
MA1122391041C0700X
MA765222084P0800X
MA1583542084P0800X
MA810522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763040Medicaid
MAM21664Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
MA9763040Medicaid