Provider Demographics
NPI:1568476059
Name:WANG, CHARLES (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHI-LUN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD,PA
Mailing Address - Street 1:1700 WAWASET ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2142
Mailing Address - Country:US
Mailing Address - Phone:302-655-1500
Mailing Address - Fax:302-655-4084
Practice Address - Street 1:1700 WAWASET ST
Practice Address - Street 2:STE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2142
Practice Address - Country:US
Practice Address - Phone:302-655-1500
Practice Address - Fax:302-655-4084
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002450207W00000X, 207WX0107X
PAMD023090E207W00000X
NJ25MA06195500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001877748Medicaid
DE0105492000OtherINDEPENDENCE BCBS
NJ3004902Medicaid
DED01194OtherMID ATLANTIC
DE2116353OtherMAMSI OPTIMUM CHOICE
DE0000187901Medicaid
D01194Medicare UPIN
DE0000187901Medicaid
DE0105492000OtherINDEPENDENCE BCBS