Provider Demographics
NPI:1447317557
Name:D'ANGELO, DAVID WALTER (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WALTER
Last Name:D'ANGELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 OLD FERN HILL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-3434
Mailing Address - Country:US
Mailing Address - Phone:610-738-2590
Mailing Address - Fax:610-738-2688
Practice Address - Street 1:915 OLD FERN HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-3434
Practice Address - Country:US
Practice Address - Phone:610-738-2590
Practice Address - Fax:610-738-2688
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007232L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA110189896Medicare Oscar/Certification
PA784-859Medicare ID - Type Unspecified
PAG09026Medicare UPIN