Provider Demographics
NPI:1528064862
Name:ANGOTTI, PAUL (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ANGOTTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MARYLAND RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1700
Mailing Address - Country:US
Mailing Address - Phone:215-659-4400
Mailing Address - Fax:215-659-5931
Practice Address - Street 1:2400 MARYLAND RD
Practice Address - Street 2:SUITE 30
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1700
Practice Address - Country:US
Practice Address - Phone:215-659-4400
Practice Address - Fax:215-659-5931
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002408L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008951000004Medicaid
480018666OtherRR MEDICARE PALMETTO GBA
PA084045Medicare ID - Type Unspecified
PA0008951000004Medicaid
1076770001Medicare NSC
PA084045GS7Medicare PIN