Provider Demographics
NPI:1871504746
Name:TANG, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:TANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NUTTAPONG
Other - Middle Name:
Other - Last Name:TANGSINMANKONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2717
Mailing Address - Country:US
Mailing Address - Phone:727-825-0111
Mailing Address - Fax:727-825-0011
Practice Address - Street 1:333 DR ML KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2717
Practice Address - Country:US
Practice Address - Phone:727-825-0111
Practice Address - Fax:727-825-0011
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78703207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49938OtherBLUE CROSS BLUE SHIELD
FL258322400Medicaid
FL278302900Medicaid
FL278302900Medicaid
FL258322400Medicaid
FL370021599Medicare PIN
FL49938XMedicare PIN