Provider Demographics
NPI:1205817913
Name:TANGUAY, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:TANGUAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:235 NORTH PEARL ST
Mailing Address - Street 2:DEPT OF PATHOLOGY
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1794
Mailing Address - Country:US
Mailing Address - Phone:508-427-3086
Mailing Address - Fax:508-588-0520
Practice Address - Street 1:235 N PEARL ST
Practice Address - Street 2:ATTN PATHOLOGY DEPT
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1794
Practice Address - Country:US
Practice Address - Phone:508-427-3086
Practice Address - Fax:508-588-0520
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2015-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA40290207ZB0001X, 207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6177875Medicaid
MAJ02611OtherBCBS
MA34295OtherHPHC
MA725136OtherTUFTS
MA6177875Medicaid
B77122Medicare UPIN