Provider Demographics
NPI:1538352877
Name:ANGEL PURDY, M.D., P.A.
Entity type:Organization
Organization Name:ANGEL PURDY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:MARLO
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-602-3656
Mailing Address - Street 1:3635 OLD COURT RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3915
Mailing Address - Country:US
Mailing Address - Phone:410-602-3656
Mailing Address - Fax:410-602-3658
Practice Address - Street 1:3635 OLD COURT RD
Practice Address - Street 2:SUITE 412
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3915
Practice Address - Country:US
Practice Address - Phone:410-602-3656
Practice Address - Fax:410-602-3658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061231208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI22808Medicare UPIN