Provider Demographics
NPI:1417913864
Name:WONG, TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 MARSH RD
Mailing Address - Street 2:PLAZA III
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4505
Mailing Address - Country:US
Mailing Address - Phone:302-475-2700
Mailing Address - Fax:302-529-7970
Practice Address - Street 1:1851 MARSH RD
Practice Address - Street 2:PLAZA III
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4505
Practice Address - Country:US
Practice Address - Phone:302-475-2700
Practice Address - Fax:302-529-7970
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE00005266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000875501Medicaid
DE0000875501Medicaid
DE010110F51Medicare ID - Type Unspecified