Provider Demographics
NPI:1720304603
Name:WONG, HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8260 ATLEE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1844
Mailing Address - Country:US
Mailing Address - Phone:804-212-6533
Mailing Address - Fax:
Practice Address - Street 1:8260 ATLEE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1844
Practice Address - Country:US
Practice Address - Phone:804-212-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2017-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA390200000X
VA0101262769207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program