Provider Demographics
NPI:1497898316
Name:PANG, ALEXANDER WY (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:WY
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEVINS ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-787-8181
Mailing Address - Fax:617-787-4644
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-787-8181
Practice Address - Fax:617-787-4644
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73668208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3075575Medicaid
MA469264OtherAETNA
MA0017559OtherNHP
MAPAJ10846OtherBCBS
MA073668OtherTHP
MA278033OtherTHP
MA073668OtherTHP