Provider Demographics
NPI:1083092910
Name:BETTELEY WANG, MEGAN E (MD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:BETTELEY WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:E
Other - Last Name:BETTELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 CLINTON AVE S
Mailing Address - Street 2:HIGHLAND FAMILY MEDICINE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1448
Mailing Address - Country:US
Mailing Address - Phone:585-279-4841
Mailing Address - Fax:
Practice Address - Street 1:480 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611
Practice Address - Country:US
Practice Address - Phone:585-436-3040
Practice Address - Fax:585-328-3812
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine