Provider Demographics
NPI:1275568958
Name:WANG, GLORIA (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-2008
Mailing Address - Country:US
Mailing Address - Phone:716-893-8550
Mailing Address - Fax:716-893-4020
Practice Address - Street 1:1595 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-2008
Practice Address - Country:US
Practice Address - Phone:716-893-8550
Practice Address - Fax:716-893-4020
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020520303OtherUNIVERA
NY080911000044OtherFIDELIS
NY1206881OtherINDEPENDENT HEALTH
NY000523591006OtherBLUE CROSS
NY000523591005OtherBLUE CROSS OF WNY