Provider Demographics
NPI:1174512438
Name:DANG, THANG N (MD)
Entity type:Individual
Prefix:DR
First Name:THANG
Middle Name:N
Last Name:DANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 WHIPPLE AVE NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7624
Mailing Address - Country:US
Mailing Address - Phone:330-966-8884
Mailing Address - Fax:
Practice Address - Street 1:6200 WHIPPLE AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7624
Practice Address - Country:US
Practice Address - Phone:330-966-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000364086OtherANTHEM
OH043700096028OtherCARESOURCE
OH1005973OtherQUALCHOICE
OH2565497Medicaid
OH2565497Medicaid
OHDA4160541Medicare ID - Type UnspecifiedMEDICARE