Basic Information
| Provider Information | |||||||||
| NPI: | 1982687075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANGIULLI | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 N ELAM AVE | ||||||||
| Address2: | STE.302 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362972271 | ||||||||
| FaxNumber: | 3362972282 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 N ELAM AVE | ||||||||
| Address2: | STE.302 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274031150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362972271 | ||||||||
| FaxNumber: | 3362972282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2005 | ||||||||
| LastUpdateDate: | 06/12/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 101661 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.