Provider Demographics
NPI:1689658437
Name:GIARDINO, ANGELA ANN (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANN
Last Name:GIARDINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:RADIOLOGY BRIGHAM & WOMENS HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-9801
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:RADIOLOGY BRIGHAM & WOMENS HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-9801
Practice Address - Fax:617-525-7333
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1505572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ55747OtherTUFTS HEALTH CARE
MAJ16662OtherBLUE CROSS BLUE SHIELD
MA3154467Medicaid
MAJ16662OtherBLUE CROSS BLUE SHIELD
G31095Medicare UPIN