Provider Demographics
NPI:1215976303
Name:PEZZELLA, ANGELO T (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:T
Last Name:PEZZELLA
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 1:17 SHAMROCK ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3024
Mailing Address - Country:US
Mailing Address - Phone:508-791-1951
Mailing Address - Fax:
Practice Address - Street 1:17 SHAMROCK ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3024
Practice Address - Country:US
Practice Address - Phone:508-791-1951
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56318208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)