Provider Demographics
NPI:1487662276
Name:WANG, NEIL P (DO)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:P
Last Name:WANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N SIERRA ST
Mailing Address - Street 2:UNIT 1112
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1349
Mailing Address - Country:US
Mailing Address - Phone:775-229-2493
Mailing Address - Fax:
Practice Address - Street 1:255 N SIERRA ST
Practice Address - Street 2:UNIT 1112
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1349
Practice Address - Country:US
Practice Address - Phone:775-229-2493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014409207P00000X
WAOP0002216207P00000X
NV1366207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487662276Medicaid
MT1487662276Medicaid
WAG8890947Medicare PIN
MIC37626063Medicare PIN