MEDICARE: GEORGE J. ANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	204597	NY
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD2005-0584	NM
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD60560473	WA

General Provider Information

NPI Number	:	1396737326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE J. ANG MD

Provider Business Mailing Address
First Line	:	1400 E KINCAID ST
Second Line	:	ATTN: CREDENTNIALING
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2500
Fax Number	:	360-428-6485

Provider Business Practice Location Address
First Line	:	1400 E KINCAID ST
Second Line	:	SKAGIT REGIONAL CLINICS
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4127
Country	:	US
Telephone Number	:	360-428-2501
Fax Number	:	360-428-2596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/05/2015

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Directions to “ GEORGE J. ANG MD” Practice Location

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