Provider Demographics
NPI:1790850519
Name:WANG, JOAN LI (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:LI
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:913 RIDGEBROOK ROAD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152
Mailing Address - Country:US
Mailing Address - Phone:410-472-1113
Mailing Address - Fax:410-472-1192
Practice Address - Street 1:913 RIDGEBROOK ROAD
Practice Address - Street 2:SUITE 314
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152
Practice Address - Country:US
Practice Address - Phone:410-472-1113
Practice Address - Fax:410-472-1192
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD22693207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E00558Medicare UPIN
9234Medicare ID - Type Unspecified