Provider Demographics
NPI:1689643470
Name:BANG, CHRISTOPHER S (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:S
Last Name:BANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 S MANNING BLVD
Mailing Address - Street 2:MEDICAL IMAGING DEPARTMENT
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1707
Mailing Address - Country:US
Mailing Address - Phone:518-525-1852
Mailing Address - Fax:518-525-1559
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:MEDICAL IMAGING DEPARTMENT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1852
Practice Address - Fax:518-525-1559
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2224502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02739706Medicaid
VT1017462Medicaid
NYRB0241Medicare PIN
NY02739706Medicaid