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General NPI Number Information
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NPI Number | 1407763683
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Entity Type | Organization
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Legal Business Name | BLACKBIRD CLINICAL SERVICES OF THE MID-ATLANTIC, PC
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Dates
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Enumeration Date | 08/25/2026
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Last Update Date | 08/25/2026
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Provider Practice Location Address
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Address Line | 1475 TANEY AVE STE 102
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City | FREDERICK
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State | MD
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Zip | 21702-5126
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Country | US
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Telephone | 301-276-7031
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Fax | 610-770-1805
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Provider Business Mailing Address
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Address Line | 1475 TANEY AVE STE 102
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City | FREDERICK
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State | MD
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Zip | 21702-5126
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Country | US
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Telephone | 301-276-7031
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Fax | 610-770-1805
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MICHAEL TANG
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Credential | MD
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Telephone | 617-821-3816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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