Provider Demographics
NPI:1144420894
Name:WANG, DAVID C (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6829 ELM ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3884
Mailing Address - Country:US
Mailing Address - Phone:703-532-4892
Mailing Address - Fax:703-237-3105
Practice Address - Street 1:6829 ELM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3884
Practice Address - Country:US
Practice Address - Phone:703-532-4892
Practice Address - Fax:703-237-3105
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202745208100000X
MAL231462208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation