Provider Demographics
NPI:1104843887
Name:HWANG, WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HWANG
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 1:4718 CARR DRIVE
Mailing Address - Street 2:PER SE TECHNOLOGIES ELLIE CONLEY
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408
Mailing Address - Country:US
Mailing Address - Phone:540-891-5764
Mailing Address - Fax:540-891-5769
Practice Address - Street 1:2121 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-681-3003
Practice Address - Fax:301-681-5868
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00635032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC80430041OtherBLUE SHIELD
MD408732100Medicaid
MD60234801OtherBLUE SHIELD
FMX026Medicare PIN
I44069Medicare UPIN
MD60234801OtherBLUE SHIELD
DC018182C85Medicare PIN
DC018183D05Medicare PIN