Provider Demographics
NPI:1376642124
Name:WONG, JAMIE F (MD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:F
Last Name:WONG
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 1:25 CAMERON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3143
Mailing Address - Country:US
Mailing Address - Phone:514-766-0766
Mailing Address - Fax:
Practice Address - Street 1:330 CHEMIN DU GOLF
Practice Address - Street 2:
Practice Address - City:VERDUN
Practice Address - State:QC
Practice Address - Zip Code:H3E2A8
Practice Address - Country:CA
Practice Address - Phone:514-766-0766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209008207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology