Provider Demographics
NPI:1417135401
Name:DANG, MYTRANG T (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MYTRANG
Middle Name:T
Last Name:DANG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0647
Mailing Address - Country:US
Mailing Address - Phone:910-483-7337
Mailing Address - Fax:910-483-0648
Practice Address - Street 1:3436 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1834
Practice Address - Country:US
Practice Address - Phone:910-426-7337
Practice Address - Fax:910-424-1418
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104212363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1417135401OtherHUMANA
NC3211349OtherUNITED HEALTHCARE
NC1281161OtherWELLPATH
NC1417135401OtherHEALTHNET FEDERAL SERVICES
NC13268728OtherPHCS/MULTIPLAN
NC1417135401OtherHEALTHSMART
NC1417135401Medicaid
NC9928411OtherAETNA
NCFH4001595OtherFIRST CAROLINA CARE
NC1281161OtherCOVENTRY OF THE CAROLINAS
NC1417135401OtherDOCTORS DIRECT
NC6602644OtherCIGNA GREATWEST
NC15235OtherBCBS OF NC
NC4015376OtherCOVENTRY NATIONAL - COVENTRY PPO
NC243133OtherMEDCOST LLC