Provider Demographics
NPI:1144379512
Name:PENG, GANG (OMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GANG
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:OMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11828 APPALOOSA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3874
Mailing Address - Country:US
Mailing Address - Phone:301-340-8444
Mailing Address - Fax:
Practice Address - Street 1:9711 MEDICAL CENTER DR STE 114
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3323
Practice Address - Country:US
Practice Address - Phone:301-340-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist