Provider Demographics
NPI:1013008317
Name:WANG, LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3648
Mailing Address - Country:US
Mailing Address - Phone:860-344-1401
Mailing Address - Fax:860-347-1023
Practice Address - Street 1:80 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3648
Practice Address - Country:US
Practice Address - Phone:860-344-1401
Practice Address - Fax:860-347-1023
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023241207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
077909OtherCONNECTICARE
2119762OtherAETNA
P3133385OtherOXFORD
010023241CT02OtherATHEM BCBS
6218842006OtherCIGNA
0V0117OtherHEALTH NET
B97503Medicare UPIN
CT040000158Medicare ID - Type Unspecified