Provider Demographics
NPI:1396739009
Name:WANG, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:CARDIAC CATHETERIZATION LAB
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-2332
Mailing Address - Fax:410-554-6544
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:CARDIAC CATHETERIZATION LAB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2332
Practice Address - Fax:410-554-6544
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0061276207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11341Medicare UPIN
000LI595Medicare ID - Type Unspecified