Provider Demographics
NPI:1679801435
Name:WANG, PENG (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PENG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6196
Mailing Address - Fax:614-366-0073
Practice Address - Street 1:800 ROSE ST # CC401B
Practice Address - Street 2:DIV OF MEDICAL ONCOLOGY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-257-4488
Practice Address - Fax:859-257-7715
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP342207RX0202X
OH35145828207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology