Provider Demographics
NPI:1043209885
Name:ZANG, DOUGLAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:ZANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4130
Mailing Address - Country:US
Mailing Address - Phone:607-697-0360
Mailing Address - Fax:607-272-0240
Practice Address - Street 1:302 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4130
Practice Address - Country:US
Practice Address - Phone:607-697-0360
Practice Address - Fax:607-272-0240
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050192207Q00000X
NY264891-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88870570Medicaid
NM87020530Medicaid
AZ945579Medicaid
NM87020530Medicaid
NM8HD905Medicare PIN
NM320059Medicare Oscar/Certification
NM8HG471Medicare PIN