Basic Information
| Provider Information | |||||||||
| NPI: | 1881695989 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGELL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64250 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109555434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10755 FALLS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | LUTHERVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210934515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105837114 | ||||||||
| FaxNumber: | 4105837128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 02/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0012405 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | D12405 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 712181400 | 05 | MD | MEDICAID |