Provider Demographics
NPI:1053339242
Name:ANGELO, STEVEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:ANGELO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1951
Mailing Address - Street 2:SAINT RAPHAEL FACULTY PHYSICIANS
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-1951
Mailing Address - Country:US
Mailing Address - Phone:508-595-0531
Mailing Address - Fax:508-829-5367
Practice Address - Street 1:1450 CHAPEL STREET
Practice Address - Street 2:SAINT RAPHAEL FACULTY PHYSICIANS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-5946
Practice Address - Fax:203-867-5534
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110006643Medicare ID - Type Unspecified
P00352521Medicare PIN
G42799Medicare UPIN
CT110009955Medicare PIN