1851310759 NPI number — BETTY YU-WAH WANG D.O.

Table of content: BETTY YU-WAH WANG D.O. (NPI 1851310759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851310759 NPI number — BETTY YU-WAH WANG D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANG
Provider First Name:
BETTY
Provider Middle Name:
YU-WAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851310759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10845 PHILADELPHIA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE MARSH
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21162-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-335-0008
Provider Business Mailing Address Fax Number:
410-335-1133

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6190 GEORGETOWN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELDERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21784-6460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-552-5050
Provider Business Practice Location Address Fax Number:
410-552-0200
Provider Enumeration Date:
07/19/2006

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: 207R00000X , with the licence number:  H0064261 , 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: 136000ZDZ4 . This is a "MEDICARE RENDERING # FOR WANGMED" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 88493004 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P424 0001 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: H5960322 . This is a "MEDICARE RENDERING # FOR CLINICAL ASSOCIATES, P.A." identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 416352400 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00725599 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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