Individual
ANGELA DEPERGOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
499 FARMINGTON AVE STE 300, FARMINGTON, CT 06032-1933
(860) 549-3210
Mailing address
499 FARMINGTON AVE STE 300, FARMINGTON, CT 06032-1933
(860) 221-8594
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
000869
CT
363AS0400X
Surgical Physician Assistant
Primary
000869
CT
363AS0400X
Surgical Physician Assistant
PA1056
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003008695
—
CT
Enumeration date
07/05/2005
Last updated
10/24/2024
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