Provider Demographics
NPI:1275069411
Name:WANG, YICHEN (MD)
Entity Type:Individual
Prefix:MR
First Name:YICHEN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:HUCHEN
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 MADISON AVENUE
Mailing Address - Street 2:THE WRIGHT CENTER FOR GRADUATE MEDICAL EDUCATION
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:570-343-4800
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9349
Practice Address - Fax:413-452-6080
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA281848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program