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1417135401

NPI Code Detail

MEDICARE: MS. MYTRANG T DANG PA-C

MEDICARE: MS. MYTRANG T DANG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	104212	NC
2	363AM0700X	Medical Physician Assistant	104212	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417135401	OTHER	NC	HUMANA
2	3211349	OTHER	NC	UNITED HEALTHCARE
3	1281161	OTHER	NC	WELLPATH
4	1417135401	OTHER	NC	HEALTHNET FEDERAL SERVICES
5	13268728	OTHER	NC	PHCS/MULTIPLAN
6	1417135401	OTHER	NC	HEALTHSMART
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	9928411	OTHER	NC	AETNA
9	FH4001595	OTHER	NC	FIRST CAROLINA CARE
10	1281161	OTHER	NC	COVENTRY OF THE CAROLINAS
11	1417135401	OTHER	NC	DOCTORS DIRECT
12	6602644	OTHER	NC	CIGNA GREATWEST
13	15235	OTHER	NC	BCBS OF NC
14	4015376	OTHER	NC	COVENTRY NATIONAL - COVENTRY PPO
15	243133	OTHER	NC	MEDCOST LLC

General Provider Information

NPI Number	:	1417135401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MYTRANG T DANG PA-C

Provider Business Mailing Address
First Line	:	PO BOX 647
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-0647
Country	:	US
Telephone Number	:	910-483-7337
Fax Number	:	910-483-0648

Provider Business Practice Location Address
First Line	:	3436 N MAIN ST
Second Line	:
City	:	HOPE MILLS
State	:	NC
Zip	:	28348-1834
Country	:	US
Telephone Number	:	910-426-7337
Fax Number	:	910-424-1418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	06/02/2016

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Directions to “ MS. MYTRANG T DANG PA-C” Practice Location

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