Provider Demographics
NPI:1235208455
Name:WANG, RICHARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13347 SANFORD AVE
Mailing Address - Street 2:SUITE C1F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5800
Mailing Address - Country:US
Mailing Address - Phone:718-961-8618
Mailing Address - Fax:718-961-0237
Practice Address - Street 1:13347 SANFORD AVE
Practice Address - Street 2:SUITE C1F
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5800
Practice Address - Country:US
Practice Address - Phone:718-961-8618
Practice Address - Fax:718-961-0237
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55518Medicare UPIN
07073GMedicare PIN