Provider Demographics
NPI:1588942395
Name:ANGELA EARHART P.A.
Entity type:Organization
Organization Name:ANGELA EARHART P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IANCULOVICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-978-5611
Mailing Address - Street 1:350 KINGWOOD MEDICAL DR STE 215
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6406
Mailing Address - Country:US
Mailing Address - Phone:832-978-5611
Mailing Address - Fax:281-407-7623
Practice Address - Street 1:350 KINGWOOD MEDICAL DR STE 215
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6406
Practice Address - Country:US
Practice Address - Phone:281-205-0204
Practice Address - Fax:281-407-7623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty