Healthcare Provider Details

I. General information

NPI: 1407763683
Provider Name (Legal Business Name): BLACKBIRD CLINICAL SERVICES OF THE MID-ATLANTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 TANEY AVE STE 102
FREDERICK MD
21702-5126
US

IV. Provider business mailing address

1475 TANEY AVE STE 102
FREDERICK MD
21702-5126
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-7031
  • Fax: 610-770-1805
Mailing address:
  • Phone: 301-276-7031
  • Fax: 610-770-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL TANG
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 617-821-3816