Provider Demographics
NPI:1770532061
Name:TANG, MARY YUH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:YUH
Last Name:TANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 W STATE HIGHWAY 114
Mailing Address - Street 2:SUITE 500-125
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8646
Mailing Address - Country:US
Mailing Address - Phone:682-223-1526
Mailing Address - Fax:817-488-6932
Practice Address - Street 1:2549 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7157
Practice Address - Country:US
Practice Address - Phone:682-223-1526
Practice Address - Fax:817-488-6932
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133231401Medicaid
TX00471MMedicare PIN
TXF08195Medicare UPIN