Healthcare Provider Details

I. General information

NPI: 1508853581
Provider Name (Legal Business Name): SAMUEL CHOW-ERN PANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FORBES RD
LEXINGTON MA
02421-7305
US

IV. Provider business mailing address

1 FORBES RD
LEXINGTON MA
02421-7305
US

V. Phone/Fax

Practice location:
  • Phone: 800-858-4832
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number77636
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: