Provider Demographics
NPI:1043272131
Name:WANG, LINGHUA (MD)
Entity Type:Individual
Prefix:
First Name:LINGHUA
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 1:1500 DISTRICT AVE STE 2119
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-5069
Mailing Address - Country:US
Mailing Address - Phone:781-608-8128
Mailing Address - Fax:855-829-6228
Practice Address - Street 1:1500 DISTRICT AVE STE 2119
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5069
Practice Address - Country:US
Practice Address - Phone:781-608-8128
Practice Address - Fax:855-829-6228
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210178208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110165625AMedicaid
MA0172090Medicaid
MAA34155Medicare ID - Type Unspecified