Provider Demographics
NPI:1841482262
Name:CHAU, BANG (MD)
Entity type:Individual
Prefix:DR
First Name:BANG
Middle Name:
Last Name:CHAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PEBBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-3112
Mailing Address - Country:US
Mailing Address - Phone:860-402-1242
Mailing Address - Fax:
Practice Address - Street 1:3016 LONGTOWN COMMONS DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7862
Practice Address - Country:US
Practice Address - Phone:803-314-0500
Practice Address - Fax:803-314-0501
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046397207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT930001557Medicare PIN