Provider Demographics
NPI:1578706032
Name:WANG, XUAN (MD PHD)
Entity Type:Individual
Prefix:
First Name:XUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 CROSSWAYS PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2047
Mailing Address - Country:US
Mailing Address - Phone:516-944-3882
Mailing Address - Fax:516-883-2936
Practice Address - Street 1:80 CROSSWAYS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2047
Practice Address - Country:US
Practice Address - Phone:516-944-3882
Practice Address - Fax:516-883-2936
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY265625207ZD0900X, 207ZP0101X
PAMD449818207ZD0900X, 207ZP0101X
VA0101255044207ZD0900X, 207ZP0101X
NJ25MA09348000207ZD0900X, 207ZP0101X
MDD0078003207ZD0900X, 207ZP0101X
DEC1-0010740207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology