Provider Demographics
NPI:1578673190
Name:TANG, STEPHEN V (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:V
Last Name:TANG
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 1:1250 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0820
Mailing Address - Fax:617-774-0832
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0820
Practice Address - Fax:617-774-0832
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54884207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA703158OtherTUFTS HEALTH PLAN
MA0014519OtherNEIGHBORHOOD HEALTH PLAN
MA7521996-003OtherCIGNA
MAPD145OtherHARVARD PILGRIM
MAJ05985OtherBLUE CROSS
MA3202577Medicaid
MAJ05985Medicare PIN
MAJ05985OtherBLUE CROSS