Provider Demographics
NPI:1316017999
Name:WANG, LINA (MD)
Entity Type:Individual
Prefix:
First Name:LINA
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 1:6161 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3932
Mailing Address - Country:US
Mailing Address - Phone:757-461-5400
Mailing Address - Fax:757-461-3305
Practice Address - Street 1:6161 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 315
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3932
Practice Address - Country:US
Practice Address - Phone:757-461-5400
Practice Address - Fax:757-461-3305
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012377862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA94945OtherOPTIMA SENTARA HMO PPO
VAP00224560OtherRAILROAD MEDICARE
VA010175542Medicaid
VA177831OtherBCBS OF VA
VA010175542Medicaid
VA177831OtherBCBS OF VA