Provider Demographics
NPI:1588661706
Name:WANG, XIA (MD)
Entity Type:Individual
Prefix:
First Name:XIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1832
Mailing Address - Country:US
Mailing Address - Phone:267-980-4622
Mailing Address - Fax:215-355-4315
Practice Address - Street 1:240 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1832
Practice Address - Country:US
Practice Address - Phone:215-750-2344
Practice Address - Fax:215-355-4315
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418474208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA17116OtherBRAVO HEALTH
PA0007133415OtherAETNA NON HMO
PA1119131OtherAETNA HMO
PAAD1781750OtherHIGHMARK BLUE SHIELD
PA2082960000OtherINDEPENDENT BLUE CROSS
PA17116OtherBRAVO HEALTH
PA2082960000OtherINDEPENDENT BLUE CROSS