Provider Demographics
NPI:1649379793
Name:WANG, SONGTAO (MD)
Entity Type:Individual
Prefix:
First Name:SONGTAO
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2109
Mailing Address - Country:US
Mailing Address - Phone:412-835-1456
Mailing Address - Fax:
Practice Address - Street 1:155 WILSON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3336
Practice Address - Country:US
Practice Address - Phone:724-223-3137
Practice Address - Fax:724-250-4395
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067940L207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018250350001Medicaid
PA057499OtherHIGHMARK BLUE SHIELD
1517940OtherGATEWAY HEALTH PLAN
PA2196825000OtherINDEPENDENCE BLUE SHIELD
000000118954OtherUNISON HEALTH PLAN
3000937OtherAETNA
P00000603OtherRAILROAD MEDICARE
217532OtherUPMC HEALTH PLAN
PA2196825000OtherINDEPENDENCE BLUE SHIELD
PA042006Medicare PIN