Provider Demographics
NPI:1780927533
Name:PANG, ERIC Q (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:Q
Last Name:PANG
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 1:601 BROADWAY FL 6
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5330
Mailing Address - Country:US
Mailing Address - Phone:206-386-2600
Mailing Address - Fax:206-264-8689
Practice Address - Street 1:601 BROADWAY FL 6
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122
Practice Address - Country:US
Practice Address - Phone:206-386-2600
Practice Address - Fax:206-264-8689
Is Sole Proprietor?:No
Enumeration Date:2013-03-30
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60970024207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029026Medicaid