Provider Demographics
NPI:1962262048
Name:WANG, LEAH (MA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:LATTERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:161 WHITTIER RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2475
Mailing Address - Country:US
Mailing Address - Phone:734-883-8621
Mailing Address - Fax:
Practice Address - Street 1:350 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6617
Practice Address - Country:US
Practice Address - Phone:844-362-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program