Provider Demographics
NPI:1720374150
Name:THANGAWNG, CAROLYN DIANE (MD, MPH, FASAM)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:DIANE
Last Name:THANGAWNG
Suffix:
Gender:F
Credentials:MD, MPH, FASAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21416 DENIT ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-1832
Mailing Address - Country:US
Mailing Address - Phone:860-709-3334
Mailing Address - Fax:
Practice Address - Street 1:BALTIMORE CENTRAL BOOKING & INTAKE
Practice Address - Street 2:300 EAST MADISON STREET
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4260
Practice Address - Country:US
Practice Address - Phone:615-660-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4644592083A0300X, 2083P0901X
MDD00878992083P0901X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103683924-000Medicaid