Provider Demographics
NPI:1316007362
Name:SOMMERSET, ANGELA RENEE (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENEE
Last Name:SOMMERSET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RENEE
Other - Last Name:SOMMERSET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,PC,INC
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5185
Mailing Address - Country:US
Mailing Address - Phone:256-461-1003
Mailing Address - Fax:256-461-1005
Practice Address - Street 1:8191 MADISON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2018
Practice Address - Country:US
Practice Address - Phone:256-461-1003
Practice Address - Fax:256-461-1005
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15965207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL96971OtherBLUE CROSS PROVIDER NUMBE
ALE87615Medicare UPIN