Provider Demographics
NPI:1396373940
Name:TANGRI, VIDUR (MD)
Entity Type:Individual
Prefix:
First Name:VIDUR
Middle Name:
Last Name:TANGRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 MEDICAL PKWY STE 350
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3081
Mailing Address - Country:US
Mailing Address - Phone:443-951-4286
Mailing Address - Fax:443-949-7380
Practice Address - Street 1:2003 MEDICAL PKWY STE 350
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3081
Practice Address - Country:US
Practice Address - Phone:443-951-4286
Practice Address - Fax:443-949-7380
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program