Healthcare Provider Details

I. General information

NPI: 1376628016
Provider Name (Legal Business Name): ANGELA ZANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HOSPITAL DR
TOWANDA PA
18848-9702
US

IV. Provider business mailing address

71 HOSPITAL DR
TOWANDA PA
18848-9702
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-6300
  • Fax: 570-268-2807
Mailing address:
  • Phone: 570-265-6300
  • Fax: 570-268-2807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD066731L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007556720061
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007556720029
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier1028284370001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: