Provider Demographics
NPI:1417148321
Name:WANG, ROBERT Y (MD FRCSC BASC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:Y
Last Name:WANG
Suffix:
Gender:M
Credentials:MD FRCSC BASC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:THE MEDICAL ART AND RESEARCH BUILDING
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06034-4037
Mailing Address - Country:US
Mailing Address - Phone:860-679-6645
Mailing Address - Fax:860-679-6649
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:THE MEDICAL ART AND RESEARCH BUILDING
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06034-4037
Practice Address - Country:US
Practice Address - Phone:860-679-6645
Practice Address - Fax:860-679-6649
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program