Provider Demographics
NPI:1447246319
Name:D'ANGELO, CLEMENT MICHAEL (DPM)
Entity type:Individual
Prefix:DR
First Name:CLEMENT
Middle Name:MICHAEL
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 ROZEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4127
Mailing Address - Country:US
Mailing Address - Phone:215-357-3668
Mailing Address - Fax:
Practice Address - Street 1:981 ROZEL AVE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4127
Practice Address - Country:US
Practice Address - Phone:215-357-3668
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002708L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023126000OtherINDEPENDENCE BLUE CROSS
PA977032Medicaid
PA0023131000OtherINDEPENDENCE BLUE CROSS
PA12509OtherELDER HEALTH
PAT29282Medicare UPIN
PA0023131000OtherINDEPENDENCE BLUE CROSS