Provider Demographics
NPI:1104853282
Name:WANG, WENCHUN (MD)
Entity Type:Individual
Prefix:
First Name:WENCHUN
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 1:14 DRAKE CIR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-3124
Mailing Address - Country:US
Mailing Address - Phone:781-784-5492
Mailing Address - Fax:
Practice Address - Street 1:14 DRAKE CIR
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-3124
Practice Address - Country:US
Practice Address - Phone:781-784-5492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159641207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3206203Medicaid
MAH14345Medicare UPIN
MA3206203Medicaid