Provider Demographics
NPI:1154880078
Name:MARTINDALE, ANGUS K (MSPC)
Entity type:Individual
Prefix:MR
First Name:ANGUS
Middle Name:K
Last Name:MARTINDALE
Suffix:
Gender:M
Credentials:MSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:AMBRIDGE
Mailing Address - State:PA
Mailing Address - Zip Code:15003-1349
Mailing Address - Country:US
Mailing Address - Phone:412-527-5463
Mailing Address - Fax:
Practice Address - Street 1:3960 WILLIAM FLYNN HWY STE 300
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101-3601
Practice Address - Country:US
Practice Address - Phone:412-527-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAPC013125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program