Basic Information
| Provider Information | |||||||||
| NPI: | 1982898599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUARTE | ||||||||
| FirstName: | ANGELICA | ||||||||
| MiddleName: | PAOLA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8950 WATERCREST CIR W | ||||||||
| Address2: | |||||||||
| City: | PARKLAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330762691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176454066 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4300 LONDONDERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171095317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176577332 | ||||||||
| FaxNumber: | 7179204394 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2007 | ||||||||
| LastUpdateDate: | 12/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT187646 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD440724 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | MD440724 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102605638 | 05 | PA | MEDICAID | MT187646 | 01 | PA | LICENSE | OTHER |