Provider Demographics
NPI:1346218690
Name:TANG, MAGGIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:
Last Name:TANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 WALSH LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8941
Mailing Address - Country:US
Mailing Address - Phone:479-750-7256
Mailing Address - Fax:479-750-7442
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:FAYETTEVILLE VAMC
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-750-7256
Practice Address - Fax:479-750-7442
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2007-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF72161Medicare UPIN