Provider Demographics
NPI:1598880031
Name:WANG, SUSAN M (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:WANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2068 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4634
Mailing Address - Country:US
Mailing Address - Phone:203-701-6787
Mailing Address - Fax:203-693-2955
Practice Address - Street 1:2068 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4634
Practice Address - Country:US
Practice Address - Phone:203-701-6787
Practice Address - Fax:203-693-2955
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045440207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT460000127Medicare PIN