Provider Demographics
NPI:1396997318
Name:SIMMONS, ANGELA D (DO)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:JULIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-526-5600
Mailing Address - Fax:724-526-3289
Practice Address - Street 1:419 KELLYS WAY
Practice Address - Street 2:
Practice Address - City:EAST BRADY
Practice Address - State:PA
Practice Address - Zip Code:16028-0000
Practice Address - Country:US
Practice Address - Phone:724-526-5600
Practice Address - Fax:724-526-3289
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA190344MB8Medicare PIN