Provider Demographics
NPI:1316901721
Name:ANGOTT, BRENT E (DO)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:E
Last Name:ANGOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9720
Mailing Address - Country:US
Mailing Address - Phone:724-222-9500
Mailing Address - Fax:724-222-9523
Practice Address - Street 1:88 WELLNESS WAY
Practice Address - Street 2:BUILDING 3
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-222-9500
Practice Address - Fax:724-222-9523
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010507L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
320540OtherUPMC
PA1948142Medicaid
1604150OtherHIGHMARK
H81750Medicare UPIN
PA078721Medicare ID - Type Unspecified