Provider Demographics
NPI:1730136144
Name:WANG, LAURA TING-HAO (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:TING-HAO
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:101 HALTON VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6825
Practice Address - Country:US
Practice Address - Phone:864-455-1600
Practice Address - Fax:864-286-5298
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22843207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863038OtherBCBS OF SC ID
SC6621985OtherCIGNA ID
SC160054743OtherRR MEDICARE
SCT70223Medicaid
SC5235368OtherAETNA ID
SC5235368OtherAETNA ID
SCG407377951Medicare PIN
SCG40737Medicare UPIN