Provider Demographics
NPI:1558328641
Name:ZHANG, MENGTAO (MD)
Entity Type:Individual
Prefix:
First Name:MENGTAO
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3588
Mailing Address - Country:US
Mailing Address - Phone:508-473-1480
Mailing Address - Fax:508-473-1210
Practice Address - Street 1:1003 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1826
Practice Address - Country:US
Practice Address - Phone:088-830-6005
Practice Address - Fax:508-883-5990
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA215396207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2143801Medicaid
RI7010054Medicaid
H69705Medicare UPIN
MA284701Medicare UPIN
RI7010054Medicaid