Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 245993 | NY |
Y | 207N00000X | Dermatologist | ME108749 | FL |
NPI | 1043406150 |
---|---|
Provider Name | Dr. Angela Giancola Weatherall |
First Address | Boca Raton, FL 33433-3426 |
Second Address | Boca Raton, FL 33433-3426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2007 |
Last Update Date | 06/05/2013 |