Provider Demographics
NPI:1568704302
Name:FUGATE, ANGELA LEA (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LEA
Last Name:FUGATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:LEA
Other - Last Name:DISMUKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:124 E NORTHFIELD DR STE F320
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2600
Mailing Address - Country:US
Mailing Address - Phone:317-588-2802
Mailing Address - Fax:317-565-4645
Practice Address - Street 1:124 E NORTHFIELD DR STE F320
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2600
Practice Address - Country:US
Practice Address - Phone:317-588-2802
Practice Address - Fax:317-565-4645
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01078223A207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty