Provider Demographics
NPI:1386804052
Name:MOUHLAS, ANGELA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:MOUHLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 KEMPSVILLE RD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3931
Mailing Address - Country:US
Mailing Address - Phone:757-261-5000
Mailing Address - Fax:757-962-5610
Practice Address - Street 1:3601 SW 160TH AVE STE 250
Practice Address - Street 2:SUITE 1000
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6314
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252624207Q00000X, 208G00000X
NY263636208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)