Healthcare Provider Details

I. General information

NPI: 1497752604
Provider Name (Legal Business Name): STEVEN J TANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 STONEWALL SHOPS SQ
GAINESVILLE VA
20155-3891
US

IV. Provider business mailing address

PO BOX 748613
ATLANTA GA
30384-8613
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-9799
  • Fax: 703-753-9792
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101230910
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: