Provider Demographics
NPI:1720205479
Name:GIAMPAOLO, ANGELA (MD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:GIAMPAOLO
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 1:1008 MINNEQUA AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3733
Mailing Address - Country:US
Mailing Address - Phone:719-557-4919
Mailing Address - Fax:719-557-4766
Practice Address - Street 1:1008 MINNEQUA AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3733
Practice Address - Country:US
Practice Address - Phone:719-557-4919
Practice Address - Fax:719-557-4766
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0044207Q00000X
CO49079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000K3526Medicaid
NM8HN175OtherPROVDER MEDICARE #
NMHSZ196OtherMEDICARE ID PART B PTAN
NM95551271OtherPROVIDER MEDICAID #
NM95551271OtherPROVIDER MEDICAID #
NM8HN175OtherPROVDER MEDICARE #