Provider Demographics
NPI:1861572232
Name:TANGLAO, EMMANUEL C (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:C
Last Name:TANGLAO
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 1:3783 GREYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3631
Mailing Address - Country:US
Mailing Address - Phone:850-656-4980
Mailing Address - Fax:
Practice Address - Street 1:3783 GREYFIELD DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3631
Practice Address - Country:US
Practice Address - Phone:850-656-4980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDPNBMedicare ID - Type Unspecified
GAG00894Medicare UPIN