Provider Demographics
NPI:1447263082
Name:DEANGELIS, KEVIN J (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:J
Last Name:DEANGELIS
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 1:213 REECEVILLE RD
Mailing Address - Street 2:SUITE 33
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-1528
Mailing Address - Country:US
Mailing Address - Phone:610-383-5220
Mailing Address - Fax:610-383-8582
Practice Address - Street 1:213 REECEVILLE RD
Practice Address - Street 2:SUITE 33
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1528
Practice Address - Country:US
Practice Address - Phone:610-383-5220
Practice Address - Fax:610-383-8582
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-004696L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84842Medicare UPIN
PA047516JL5Medicare ID - Type UnspecifiedINDIVIDUAL #