Provider Demographics
NPI:1306157078
Name:ECHEVERRIA, ANGELA BETH (PHARMD, MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:BETH
Last Name:ECHEVERRIA
Suffix:
Gender:F
Credentials:PHARMD, MD
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Mailing Address - Street 1:2350 MIAMI VALLEY DR
Mailing Address - Street 2:STE 300
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4778
Mailing Address - Country:US
Mailing Address - Phone:937-438-8640
Mailing Address - Fax:937-438-8615
Practice Address - Street 1:2350 MIAMI VALLEY DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4778
Practice Address - Country:US
Practice Address - Phone:937-438-8640
Practice Address - Fax:937-438-8615
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72234208600000X
FLME129595208600000X
ORMD2244382086S0129X
AZ500652086S0129X
OH35.1402452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0412130Medicaid