Provider Demographics
NPI:1679562789
Name:TANGUILIG, GERALD G (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:G
Last Name:TANGUILIG
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:97 LIBBEY INDUSTRIAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EAST WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3110
Mailing Address - Country:US
Mailing Address - Phone:781-331-3300
Mailing Address - Fax:781-337-8356
Practice Address - Street 1:23 WHITES PATH
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1221
Practice Address - Country:US
Practice Address - Phone:508-398-6131
Practice Address - Fax:508-398-7440
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA160753207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3198502Medicaid
G96619Medicare UPIN
MAA29833Medicare ID - Type Unspecified