Provider Demographics
NPI:1417184144
Name:WANG, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1208B VFW PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-4349
Mailing Address - Country:US
Mailing Address - Phone:617-608-1575
Mailing Address - Fax:617-608-1576
Practice Address - Street 1:1208B VFW PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4349
Practice Address - Country:US
Practice Address - Phone:617-608-1575
Practice Address - Fax:617-608-1576
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2014-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA240628207R00000X
MA256901207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine