Provider Demographics
NPI:1992777627
Name:MANCUSO, ANGELO (DO)
Entity type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:MANCUSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2828 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1538
Mailing Address - Country:US
Mailing Address - Phone:256-351-9077
Mailing Address - Fax:256-351-0294
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8959
Practice Address - Country:US
Practice Address - Phone:256-772-9996
Practice Address - Fax:256-772-0294
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-196207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology