Provider Demographics
NPI:1467105437
Name:WONG, ANNIE YE (PA)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:YE
Last Name:WONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:200 HARRISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1836
Mailing Address - Country:US
Mailing Address - Phone:617-636-0405
Mailing Address - Fax:
Practice Address - Street 1:200 HARRISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1836
Practice Address - Country:US
Practice Address - Phone:617-636-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant