Provider Demographics
NPI:1982688651
Name:TANG, JOHNNY (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:TANG
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 1:51 STATE RD
Mailing Address - Street 2:
Mailing Address - City:N DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-994-1400
Mailing Address - Fax:508-910-2212
Practice Address - Street 1:51 STATE RD
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-994-1400
Practice Address - Fax:508-910-2212
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223834207W00000X
OH35089979207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110041262AMedicaid
MAI35199Medicare UPIN
MAS400154436Medicare PIN
OH421824OtherWELLCARE
OHTA4215861Medicare PIN
OH7116695OtherAETNA
OHP00420612OtherRAILROAD MEDICARE
OH000000530756OtherANTHEM
OH751188OtherBUCKEYE
MAI35199Medicare UPIN
MAA38807Medicare ID - Type Unspecified