Provider Demographics
NPI:1497896799
Name:HEROPOULOS, ANGELO NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:NICHOLAS
Last Name:HEROPOULOS
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 1:157 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-6537
Mailing Address - Country:US
Mailing Address - Phone:650-854-1833
Mailing Address - Fax:
Practice Address - Street 1:1141 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3241
Practice Address - Country:US
Practice Address - Phone:559-891-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048718207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487180Medicaid
CA00A487182Medicare PIN
CA00A487184Medicare PIN
CA00A487183Medicare PIN
CAF46529Medicare UPIN