Provider Demographics
NPI:1609020049
Name:CORAZON G. TABLANG MD PC
Entity Type:Organization
Organization Name:CORAZON G. TABLANG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:G
Authorized Official - Last Name:TABLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-317-0020
Mailing Address - Street 1:529 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3766
Mailing Address - Country:US
Mailing Address - Phone:302-678-3408
Mailing Address - Fax:301-317-0028
Practice Address - Street 1:10 DARWIN DR STE C
Practice Address - Street 2:DARWIN PROFESSIONAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-6658
Practice Address - Country:US
Practice Address - Phone:302-453-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006036207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051981Medicare PIN