Provider Demographics
NPI:1750320750
Name:WONG, MING T (MD)
Entity Type:Individual
Prefix:
First Name:MING
Middle Name:T
Last Name:WONG
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 1:196 HARVARD AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2829
Mailing Address - Country:US
Mailing Address - Phone:617-254-5805
Mailing Address - Fax:
Practice Address - Street 1:196 HARVARD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2829
Practice Address - Country:US
Practice Address - Phone:617-254-5805
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine