Provider Demographics
NPI:1316992902
Name:WANG, CONG (MD)
Entity type:Individual
Prefix:
First Name:CONG
Middle Name:
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 1:2 COLUMBIA DR
Mailing Address - Street 2:SUITE A327
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3508
Mailing Address - Country:US
Mailing Address - Phone:813-844-4396
Mailing Address - Fax:813-844-4972
Practice Address - Street 1:2 COLUMBIA DR
Practice Address - Street 2:SUITE: A-327
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3508
Practice Address - Country:US
Practice Address - Phone:813-844-4434
Practice Address - Fax:813-844-8458
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90325207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00230761OtherMEDICARE RAILROAD
FL50170OtherFL BCBS
FLI23975Medicare UPIN
FL50170Medicare ID - Type UnspecifiedFL MEDICARE
FL50170ZMedicare ID - Type UnspecifiedFGTBA MEDICARE
FL50170YMedicare ID - Type UnspecifiedGTBA MEDICARE