Provider Demographics
NPI:1811907504
Name:ANGEL, CYNTHIA (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:ANGEL
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 1:125 LATTIMORE RD
Mailing Address - Street 2:SUITE 258
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4159
Mailing Address - Country:US
Mailing Address - Phone:585-442-8077
Mailing Address - Fax:585-442-8039
Practice Address - Street 1:125 LATTIMORE RD
Practice Address - Street 2:SUITE 258
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-442-8077
Practice Address - Fax:585-442-8039
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151104207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00883445Medicaid
NYC58203Medicare UPIN
NY00883445Medicaid