Basic Information
| Provider Information | |||||||||
| NPI: | 1477618064 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGERMEIER | ||||||||
| FirstName: | MARLA | ||||||||
| MiddleName: | CATHLEEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 MAIN ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783717010 | ||||||||
| FaxNumber: | 9783710522 | ||||||||
| Practice Location | |||||||||
| Address1: | 148 W RIVER ST | ||||||||
| Address2: | SUITE 1 B | ||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029042615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4012739310 | ||||||||
| FaxNumber: | 4012731270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 6161 | RI | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 003626 | 01 | RI | BLUE CHIP | OTHER | 2741 | 01 | RI | BLUE CROSS | OTHER | 070001832 | 01 | RI | RAILROAD MEDICARE | OTHER | 050423719 | 01 | RI | UNITED HEALTH PLAN | OTHER | 900274 | 05 | RI | MEDICAID |