Provider Demographics
NPI:1306427463
Name:WANG, TAO
Entity type:Individual
Prefix:DR
First Name:TAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TAO
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD,
Mailing Address - Street 1:65 ORCHARD WAY N
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-6127
Mailing Address - Country:US
Mailing Address - Phone:301-938-2519
Mailing Address - Fax:
Practice Address - Street 1:65 ORCHARD WAY N
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-6127
Practice Address - Country:US
Practice Address - Phone:301-938-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00886171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist