Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MT206736 | PA |
N | 208600000X | Surgeon | MT206736 | PA |
Y | 208800000X | Urologist | TP650 | KY |
NPI | 1053724278 |
---|---|
Provider Name | Dr. Meredith Angel |
First Address | Campbellsville, KY 42718-9662 |
Second Address | Campbellsville, KY 42718-9662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 06/08/2019 |