Provider Demographics
NPI:1497166110
Name:WANG, SIJIE JASON (MD)
Entity Type:Individual
Prefix:
First Name:SIJIE
Middle Name:JASON
Last Name:WANG
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 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-7539
Mailing Address - Country:US
Mailing Address - Phone:860-679-4477
Mailing Address - Fax:603-227-7191
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-7539
Practice Address - Country:US
Practice Address - Phone:860-679-4477
Practice Address - Fax:603-227-7191
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18011207R00000X, 208M00000X
CT070663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist