Provider Demographics
NPI:1194914168
Name:DANGELO, RAPHAEL J (MD)
Entity type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:J
Last Name:DANGELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 S YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2026
Mailing Address - Country:US
Mailing Address - Phone:303-721-9984
Mailing Address - Fax:303-267-4566
Practice Address - Street 1:7030 S YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2026
Practice Address - Country:US
Practice Address - Phone:303-721-9984
Practice Address - Fax:303-267-4566
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD34559Medicare UPIN
COC810177Medicare PIN