Basic Information
| Provider Information | |||||||||
| NPI: | 1962516088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANGELO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 N. SEVENTH STREET | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172673000 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 08/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN352303L | PA | N | Nursing Service Providers | Registered Nurse | 207L00000X | ARNP9174012 | FL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | RN352303L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | RN352303L | 01 | PA | PA LICENSE | OTHER | 50082259 | 01 | PA | CAPITAL BLUECROSS | OTHER | 050514 | 01 | PA | MEDICARE GROUP # | OTHER | 1007307260035 | 01 | PA | MEDICAID GROUP # | OTHER | P00741675 | 01 | PA | RAILROAD MEDICARE | OTHER | 050514 | 01 | PA | GROUP MEDICARE # | OTHER | 102238305 0001 | 05 | PA | MEDICAID | 304550100 | 05 | FL | MEDICAID |