Provider Demographics
NPI:1982898599
Name:DUARTE, ANGELICA PAOLA (MD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:PAOLA
Last Name:DUARTE
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 1:8950 WATERCREST CIR W
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2691
Mailing Address - Country:US
Mailing Address - Phone:717-645-4066
Mailing Address - Fax:
Practice Address - Street 1:4300 LONDONDERRY ROAD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5317
Practice Address - Country:US
Practice Address - Phone:717-657-7332
Practice Address - Fax:717-920-4394
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT187646207R00000X
PAMD440724208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102605638Medicaid
PAMT187646OtherLICENSE