Active NPI
Paul R Tanguay, MD
- Anatomic Pathology & Clinical Pathology Physician
- Brockton, MA
National Provider Identifier
1205817913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 40290
- Practice address
- 235 N Pearl St
Attn Pathology Dept
Brockton, MA 02301-1794 - Phone
- (508) 427-3086
- Fax
- (508) 588-0520
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Blood Banking & Transfusion Medicine Physician | 207ZB0001X | 40290 | MA | |
| Cytopathology Physician | 207ZC0500X | 40290 | MA | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 40290 | MA | Primary |
Addresses
Primary practice location
235 N Pearl St
Attn Pathology Dept
Brockton, MA 02301-1794
Mailing address
235 North Pearl St
Dept of Pathology
Brockton, MA 02301-1794
Phone (508) 427-3086
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6177875 | Medicaid | MA | |
| J02611 | Other | MA | BCBS |
| 34295 | Other | MA | HPHC |
| 725136 | Other | MA | TUFTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40290 | MA | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445212800000",
"number": "1205817913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "235 NORTH PEARL ST",
"address_2": "DEPT OF PATHOLOGY",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011794",
"telephone_number": "508-427-3086",
"fax_number": "508-588-0520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 N PEARL ST",
"address_2": "ATTN PATHOLOGY DEPT",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011794",
"telephone_number": "508-427-3086",
"fax_number": "508-588-0520"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANGUAY",
"first_name": "PAUL",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2015-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207ZB0001X",
"taxonomy_group": "",
"desc": "Pathology, Blood Banking & Transfusion Medicine",
"state": "MA",
"license": "40290",
"primary": false
},
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "MA",
"license": "40290",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MA",
"license": "40290",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6177875",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "J02611",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC",
"identifier": "34295",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "725136",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.