Basic Information
Provider Information | |||||||||
NPI: | 1841272986 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | D'ANGELO | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | G. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 722 NEWMAN RD | ||||||||
Address2: |   | ||||||||
City: | NEW BERN | ||||||||
State: | NC | ||||||||
PostalCode: | 285625238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2526335057 | ||||||||
FaxNumber: | 2526330084 | ||||||||
Practice Location | |||||||||
Address1: | 720 NEWMAN RD | ||||||||
Address2: |   | ||||||||
City: | NEW BERN | ||||||||
State: | NC | ||||||||
PostalCode: | 285625238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2526335057 | ||||||||
FaxNumber: | 2526330084 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/15/2005 | ||||||||
LastUpdateDate: | 10/29/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/29/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine |   | 2085B0100X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0204X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0205X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085U0001X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 9701307 | NC | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085D0003X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085N0700X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0203X | 9701307 | NC | N |   | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
ID | Type | State | Issuer | Description | 760158 | 01 | NC | MAMSI | OTHER | C5186 | 01 | NC | MEDCOST | OTHER | 1141F | 01 | NC | BCBS OF NC | OTHER | 146906 | 01 | NC | VYTRA | OTHER | 891141F | 05 | NC |   | MEDICAID | 153000500 | 01 | NC | DOL | OTHER |