Provider Demographics
NPI:1104919281
Name:PECHA, ANGELA RAMBALAKOS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:RAMBALAKOS
Last Name:PECHA
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 1:206 PEPPERBUSH RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5714
Mailing Address - Country:US
Mailing Address - Phone:502-394-9490
Mailing Address - Fax:
Practice Address - Street 1:8134 NEW LAGRANGE RD
Practice Address - Street 2:STE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4676
Practice Address - Country:US
Practice Address - Phone:502-412-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 31588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50013898OtherPASSPORT
KY64951429Medicaid
KY000000501933OtherANTHEM
KY000000501933OtherANTHEM