Provider Demographics
NPI:1003205303
Name:WANG, FANG (PHD, MAC)
Entity Type:Individual
Prefix:DR
First Name:FANG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD, MAC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 214
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:240-328-8169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02215171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist