Basic Information
| Provider Information | |||||||||
| NPI: | 1568613909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANSERA | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MARYANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8926 WOODYARD RD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207354220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018566718 | ||||||||
| FaxNumber: | 3018566722 | ||||||||
| Practice Location | |||||||||
| Address1: | 7801 OLD BRANCH AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | CLINTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207351608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018566718 | ||||||||
| FaxNumber: | 3018566722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2008 | ||||||||
| LastUpdateDate: | 02/01/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | C2-0008725 | DE | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1568613909 | 05 | VA | MEDICAID | 447817700 | 05 | MD | MEDICAID |