Provider Demographics
NPI:1811997273
Name:WINGATE, ANGELA (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WINGATE
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 1:209 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2312
Mailing Address - Country:US
Mailing Address - Phone:802-442-0158
Mailing Address - Fax:802-442-0160
Practice Address - Street 1:209 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-2312
Practice Address - Country:US
Practice Address - Phone:802-442-0158
Practice Address - Fax:802-442-0160
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
50118000109OtherFIDELITY
VT0049901OtherBC/BS
7694525OtherAETNA
10053531OtherCDPHP
5348525OtherCIGNA
VT0VN2535Medicaid
08328OtherMVP
10053531OtherCDPHP
C36714Medicare UPIN