Provider Demographics
NPI:1689671190
Name:ANGELES, CARMICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CARMICHAEL
Middle Name:
Last Name:ANGELES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROUTE 347
Mailing Address - Street 2:BLDG 14A
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2554
Mailing Address - Country:US
Mailing Address - Phone:631-689-7800
Mailing Address - Fax:
Practice Address - Street 1:2500 ROUTE 347
Practice Address - Street 2:BLDG 14A
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2554
Practice Address - Country:US
Practice Address - Phone:631-689-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2255725207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2949859OtherOXFORD
NY02410768Medicaid
NYP00073812OtherMEDICARE RAILROAD
NY148301OtherVYTRA
NY6X8591OtherEMPIRE BLUECROSS BLUESHIE
NY148301OtherVYTRA
NY02410768Medicaid