Provider Demographics
NPI:1124079355
Name:WANG, MING R (MD)
Entity type:Individual
Prefix:
First Name:MING
Middle Name:R
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 N GALEN HALL RD
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-9331
Mailing Address - Country:US
Mailing Address - Phone:610-743-2332
Mailing Address - Fax:
Practice Address - Street 1:243 N GALEN HALL RD
Practice Address - Street 2:
Practice Address - City:WERNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19565-9331
Practice Address - Country:US
Practice Address - Phone:610-743-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446668207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47078557501Medicaid
NEF09646Medicare UPIN
NE47078557501Medicaid