Provider Demographics
NPI:1306061767
Name:WONG, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 RENFREW AVENUE
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:ON
Mailing Address - Zip Code:K1S1Z8
Mailing Address - Country:CA
Mailing Address - Phone:613-941-7539
Mailing Address - Fax:
Practice Address - Street 1:JEANNE MANCE BUILDING - 6TH FLOOR
Practice Address - Street 2:TUNNEY'S PASTURE
Practice Address - City:OTTAWA
Practice Address - State:ON
Practice Address - Zip Code:K1AOL2
Practice Address - Country:CA
Practice Address - Phone:613-941-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76969207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease