Provider Demographics
NPI:1710650411
Name:WANG, CHARLES (MD / PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
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:ATTN: INTERNAL MEDICINE
Mailing Address - Street 2:5501 OLD YORK RD
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:408-858-3129
Mailing Address - Fax:
Practice Address - Street 1:ATTN: INTERNAL MEDICINE
Practice Address - Street 2:5501 OLD YORK RD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:408-858-3129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT224562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine