Provider Demographics
NPI:1316498306
Name:LINDA C WANG, MD, LLC
Entity type:Organization
Organization Name:LINDA C WANG, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-288-1870
Mailing Address - Street 1:1205 YORK RD STE 39A
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6219
Mailing Address - Country:US
Mailing Address - Phone:443-288-1870
Mailing Address - Fax:443-288-6639
Practice Address - Street 1:1205 YORK RD STE 39A
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6219
Practice Address - Country:US
Practice Address - Phone:443-288-1870
Practice Address - Fax:443-288-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0072992207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty