1568476059 NPI number — CHARLES WANG MD

Table of content: CHARLES WANG MD (NPI 1568476059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568476059 NPI number — CHARLES WANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
CHARLES
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WANG
Provider Other First Name:
CHI-LUN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD,PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568476059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 WAWASET ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19806-2142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-655-1500
Provider Business Mailing Address Fax Number:
302-655-4084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 WAWASET ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19806-2142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-655-1500
Provider Business Practice Location Address Fax Number:
302-655-4084
Provider Enumeration Date:
07/28/2006

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: 207W00000X , with the licence number:  C10002450 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: MD023090E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 25MA06195500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0107X , with the licence number: C10002450 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 001877748 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0105492000 . This is a "INDEPENDENCE BCBS" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 3004902 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: D01194 . This is a "MID ATLANTIC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2116353 . This is a "MAMSI OPTIMUM CHOICE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000187901 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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