Provider Demographics
NPI:1568453983
Name:TANGUAY, NORMAND A (MD)
Entity Type:Individual
Prefix:
First Name:NORMAND
Middle Name:A
Last Name:TANGUAY
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 1:136 W NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1203
Mailing Address - Country:US
Mailing Address - Phone:978-988-6209
Mailing Address - Fax:978-988-6139
Practice Address - Street 1:500 SALEM ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1200
Practice Address - Country:US
Practice Address - Phone:978-988-6209
Practice Address - Fax:978-988-6139
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3189988Medicaid
MAG46317Medicare ID - Type Unspecified
MA3189988Medicaid