Provider Demographics
NPI:1588293880
Name:WANG, EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:702-671-2376
Practice Address - Street 1:HOSPITALIST
Practice Address - Street 2:1100 CENTRAL AVE SE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-724-6124
Practice Address - Fax:505-724-6125
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-07-03
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Provider Licenses
StateLicense IDTaxonomies
NMDO2023-0628207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine