Provider Demographics
NPI:1235158536
Name:TANG, MARY E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:TANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:FAHC PATHOLOGY ACC-EP1
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-5121
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:FLETCHER ALLEN HEALTH CARE, PATHOLOGY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-5121
Practice Address - Fax:802-847-3987
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0008183207ZP0007X, 207ZP0102X, 207ZP0104X
VT042.0008183207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN0654Medicaid
NY01413969Medicaid
VTTAVN0654Medicare ID - Type Unspecified
NY01413969Medicaid