Healthcare Provider Details

I. General information

NPI: 1962664193
Provider Name (Legal Business Name): MARGOT NEWBURGER TANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARGOT LOUISE NEWBURGER M.D.

II. Dates (important events)

Enumeration Date: 06/29/2008
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE YACC 5
BOSTON MA
02118-4001
US

IV. Provider business mailing address

720 HARRISON AVE DOB 503
BOSTON MA
02118-2371
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4841
  • Fax: 617-414-5714
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number237675
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number246725
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: