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General NPI Number Information
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NPI Number | 1346218690
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Entity Type | Individual
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Provider Name | MAGGIE TANG M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/11/2006
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Last Update Date | 07/14/2007
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Provider Practice Location Address
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Address Line | 1100 N COLLEGE AVE FAYETTEVILLE VAMC
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-1944
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Country | US
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Telephone | 479-750-7256
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Fax | 479-750-7442
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Provider Business Mailing Address
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Address Line | 5511 WALSH LN
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City | ROGERS
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State | AR
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Zip | 72758-8941
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Country | US
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Telephone | 479-750-7256
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Fax | 479-750-7442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | E4211
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License Number State | AR
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