Provider Demographics
NPI:1053353193
Name:DE BONE, ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:DE BONE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8116 GOOD LUCK RD
Mailing Address - Street 2:SUITE 010
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:240-965-4413
Mailing Address - Fax:240-542-2997
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:SUITE 010
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:240-965-4413
Practice Address - Fax:240-542-2997
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002719363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant