1942279518 NPI number — DR. ALBERT KINTIM WONG M.D.

Table of content: DR. ALBERT KINTIM WONG M.D. (NPI 1942279518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942279518 NPI number — DR. ALBERT KINTIM WONG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WONG
Provider First Name:
ALBERT
Provider Middle Name:
KINTIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WONG
Provider Other First Name:
KINTIM
Provider Other Middle Name:
ALBERT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942279518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 KNOLL NORTH DR STE 490
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-2380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-964-1200
Provider Business Mailing Address Fax Number:
410-964-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 KNOLL NORTH DR STE 490
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21045-2380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-964-1200
Provider Business Practice Location Address Fax Number:
410-964-1002
Provider Enumeration Date:
03/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ND0900X , with the licence number:  D0025635 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: D0025635 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 301231000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".