Provider Demographics
NPI:1497748008
Name:WANG, KER-SHI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:KER-SHI
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 784305
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-4305
Mailing Address - Country:US
Mailing Address - Phone:844-565-6473
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-574-6851
Practice Address - Fax:202-279-7370
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046604L207L00000X, 207LP2900X
MDD0039769207L00000X
DCMD042715207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherHEALTHNET/TRICARE
PA25-1716306OtherMULTIPLAN/PHCS
PA001291501 0004Medicaid
PA2154665OtherMAMSI
PA25-1716306OtherINTERGROUP
PA25-1716306OtherINFORMED
PA4603436OtherAETNA NON-HMO
PA6906165OtherAETNA HMO
PA25-1716306OtherDEVON
PA120420418OtherDEPT OF LABOR
PAWA2089555OtherHIGHMARK BLUESHIELD
PA1007307260036OtherMEDICAID GROUP #
PA268482OtherUNISON
PA050514OtherMEDICARE GROUP #
PA25-1716306OtherFIRST HEALTH
PAP00724056OtherRAILROAD MEDICARE
PAPEARL PROVIDEROtherHEALTH AMERICA
PA1582458OtherGATEWAY
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA50084227OtherCAPITAL BLUECROSS
PA25-1716306OtherHEALTHNET/TRICARE
PA729104P1KMedicare PIN
MD727M0906Medicare PIN
PAF32367Medicare UPIN