Provider Demographics
NPI:1629085147
Name:PANG, MAYNARD K (MD)
Entity Type:Individual
Prefix:
First Name:MAYNARD
Middle Name:K
Last Name:PANG
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 1:250 PLEASANT ST
Mailing Address - Street 2:SUITE 6073
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7539
Mailing Address - Country:US
Mailing Address - Phone:603-227-7000
Mailing Address - Fax:603-227-7191
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:SUITE 6073
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-227-7000
Practice Address - Fax:603-227-7191
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12219207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204363Medicaid
NC5908841Medicaid
NC1473COtherBLUECROSS BLUESHIELD
NC812443OtherBLUE MEDICARE
NCP00479038OtherRAILROAD MEDICARE
H23872Medicare UPIN
NC2022055Medicare PIN
NC812443OtherBLUE MEDICARE