Provider Demographics
NPI:1144384223
Name:NG, WILLIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:A
Last Name:NG
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 1:3330 ERIE AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1656
Mailing Address - Country:US
Mailing Address - Phone:513-321-0199
Mailing Address - Fax:513-321-0301
Practice Address - Street 1:3330 ERIE AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1656
Practice Address - Country:US
Practice Address - Phone:513-321-0199
Practice Address - Fax:513-321-0301
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-9696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics