Provider Demographics
NPI:1497515308
Name:ANGELO, SOPHIA JOHANNA (MD)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:JOHANNA
Last Name:ANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HARRISON AVENUE
Mailing Address - Street 2:BCD BUILDING, 5TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-638-7066
Mailing Address - Fax:
Practice Address - Street 1:800 HARRISON AVENUE
Practice Address - Street 2:BCD BUILDING, 5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3016476207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology