Provider Demographics
NPI:1194911909
Name:D'URSO, ANGELA A (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:A
Last Name:D'URSO
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 1:5 MORGAN DALE CT
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8849
Mailing Address - Country:US
Mailing Address - Phone:610-913-1303
Mailing Address - Fax:
Practice Address - Street 1:5 MORGAN DALE CT
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-8849
Practice Address - Country:US
Practice Address - Phone:610-913-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2007-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057762L207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8013209Medicaid
MN8013209Medicaid