Provider Demographics
NPI:1356846927
Name:D'ANGELO, OLIVIA MARY (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARY
Last Name:D'ANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6527 EAGLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 OSPREY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4347
Practice Address - Country:US
Practice Address - Phone:863-519-1799
Practice Address - Fax:863-229-7550
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME166917208600000X
GA103445208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery