Basic Information
| Provider Information | |||||||||
| NPI: | 1528061983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANGELO | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 E THOMAS RD BLDG 2108 | ||||||||
| Address2: | STE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850167710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029331813 | ||||||||
| FaxNumber: | 6029331820 | ||||||||
| Practice Location | |||||||||
| Address1: | 879 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243578198 | ||||||||
| FaxNumber: | 6029330222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 07/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 48304 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 10892 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD056517L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30200740 | 05 | NH | MEDICAID | 578117NWB | 01 | PA | MEDICARE | OTHER | 12561940 | 01 | PA | MULTIPLAN | OTHER | 222594672 | 01 | NH | PRIVATE HEALTHCARE ID | OTHER | 2547667 | 01 | PA | CIGNA | OTHER | 30703781 | 01 | PA | AMERIHEALTH CARITAS & VIP | OTHER | 888567 | 01 | PA | UPMC | OTHER | QZZ000000208841 | 01 | PA | AETNA BETTER HEALTH | OTHER | 371509 | 01 | NH | MVP ID# | OTHER | 713530 | 01 | NH | HARVARD PILGRIM ID# | OTHER | 3017025 | 01 | NH | AETNA ID# | OTHER | 35973 | 01 | NH | CIGNA ID# | OTHER | P023475 | 01 | PA | GATEWAY | OTHER | 003607668 | 01 | PA | HIGHMARK | OTHER | 103284080 | 05 | PA | MEDICAID | 222594672 | 01 | NH | TRICARE ID | OTHER | 222594672 | 01 | NH | GREATWEST HEALTHCARE | OTHER | 7599428 | 01 | PA | AETNA | OTHER | 01YP02430NH01 | 01 | NH | ANETHEM ID# | OTHER | 222594672 | 01 | NH | UNITED HEALTHCARE ID | OTHER | 080186867 | 01 | NH | RAILROAD MEDICARE ID | OTHER | 222594672 | 01 | NH | HEALTHCARE VALUE MANAGE# | OTHER | 2248512 | 01 | PA | UNITED HEALTHCARE | OTHER |