Provider Demographics
NPI:1124293873
Name:WANG, BRANT G (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BRANT
Middle Name:G
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:GANG
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 37504
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3504
Mailing Address - Country:US
Mailing Address - Phone:703-321-3700
Mailing Address - Fax:703-321-3701
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-798-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248829207ZC0500X
MDD0067139207ZP0102X
TXV1644207ZC0500X, 207ZP0102X
DCMD037901207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology