Provider Demographics
NPI:1265919161
Name:VANG, ALEXANDER (RDMS, RVT)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:RDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HEARTLAND TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1966
Mailing Address - Country:US
Mailing Address - Phone:608-841-1009
Mailing Address - Fax:608-807-5159
Practice Address - Street 1:725 HEARTLAND TRL STE 205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1966
Practice Address - Country:US
Practice Address - Phone:608-841-1009
Practice Address - Fax:608-807-5159
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1470872471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography