Provider Demographics
NPI:1841568714
Name:B. G. YANGCO, M.D., P.A.
Entity Type:Organization
Organization Name:B. G. YANGCO, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAD
Authorized Official - Middle Name:
Authorized Official - Last Name:YANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-875-1024
Mailing Address - Street 1:4620 N HABANA AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7107
Mailing Address - Country:US
Mailing Address - Phone:813-875-4375
Mailing Address - Fax:813-875-4376
Practice Address - Street 1:4620 N HABANA AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7107
Practice Address - Country:US
Practice Address - Phone:813-875-4375
Practice Address - Fax:813-875-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038840800Medicaid
D 85505Medicare UPIN
FL30201Medicare PIN