Provider Demographics
NPI:1558333260
Name:WANG, DAVID S (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY ST, STE 3B
Practice Address - Street 2:SHAPIRO BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-8485
Practice Address - Fax:617-414-7372
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2024-04-11
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Provider Licenses
StateLicense IDTaxonomies
MA158460208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110033723AMedicaid
NH3117790Medicaid
MA110033723AMedicaid