Individual
DR. RAYMOND FANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-6704
(410) 328-4124
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
A63985
CA
2086S0102X
Surgical Critical Care Physician
A63985
CA
2086S0102X
Surgical Critical Care Physician
Primary
D72565
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2233132AL4
MEDICARE
MD
05
—
550108300
—
MD
Enumeration date
11/17/2005
Last updated
04/05/2023
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