Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 17122 | WV |
Y | 111NI0900X | Internist | 17122 | WV |
N | 207RG0300X | Geriatric Medicine | 17122 | WV |
NPI | 1134186331 |
---|---|
Provider Name | Dr. Peter Lee Ang |
First Address | Fairmont, WV 26554 |
Second Address | Fairmont, WV 26554-1445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 17/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6000489000 | (05) | WV |