Provider Demographics
NPI:1326554700
Name:MINANG, PAUL TANGE
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TANGE
Last Name:MINANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 DUAL HWY
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5713
Mailing Address - Country:US
Mailing Address - Phone:301-302-6858
Mailing Address - Fax:
Practice Address - Street 1:431 DUAL HWY
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5713
Practice Address - Country:US
Practice Address - Phone:301-302-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator