Provider Demographics
NPI:1073514550
Name:TANG, AYLMER C (MD)
Entity type:Individual
Prefix:
First Name:AYLMER
Middle Name:C
Last Name:TANG
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 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:12 ST PAUL DR STE 204
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6886
Practice Address - Fax:717-217-6896
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074199L207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007307260040OtherMEDICAID GROUP #
PA285049OtherUNISON
PAMD074199LOtherLICENSE
PA001857629 0002Medicaid
PA50089141OtherCAPITAL BLUECROSS
PA867633OtherMEDICARE GROUP #
PABT7340641OtherDEA
PAMD074199LOtherLICENSE