Provider Demographics
NPI:1528069002
Name:ERNST, ANGELA NOEL (MD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:NOEL
Last Name:ERNST
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:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:MONTROSS
Mailing Address - State:VA
Mailing Address - Zip Code:22520-0880
Mailing Address - Country:US
Mailing Address - Phone:804-493-9999
Mailing Address - Fax:804-493-7140
Practice Address - Street 1:18849 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MONTROSS
Practice Address - State:VA
Practice Address - Zip Code:22520-2965
Practice Address - Country:US
Practice Address - Phone:804-493-9999
Practice Address - Fax:804-493-7140
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARE6412302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA56-4587-5Medicaid
VA236254OtherANTHEM BC/BS
VA56-4587-5Medicaid
VA000551B10Medicare ID - Type Unspecified