Healthcare Provider Details

I. General information

NPI: 1154258416
Provider Name (Legal Business Name): FAN TANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE
PITTSBURGH PA
15232-1300
US

IV. Provider business mailing address

6 BIRCHWOOD CT
EAST HANOVER NJ
07936-3140
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-4989
  • Fax:
Mailing address:
  • Phone: 973-960-1887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: