Provider Demographics
NPI:1851310759
Name:WANG, BETTY YU-WAH (DO)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:YU-WAH
Last Name:WANG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-1133
Practice Address - Street 1:6190 GEORGETOWN BLVD
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6460
Practice Address - Country:US
Practice Address - Phone:410-552-5050
Practice Address - Fax:410-552-0200
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0064261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136000ZDZ4OtherMEDICARE RENDERING # FOR WANGMED
MD88493004OtherCAREFIRST
DCP424 0001OtherCAREFIRST
MDH5960322OtherMEDICARE RENDERING # FOR CLINICAL ASSOCIATES, P.A.
MD416352400OtherMEDICAL ASSISTANCE
GAP00725599OtherRAILROAD MEDICARE
GAP00725599OtherRAILROAD MEDICARE
MD136000ZBRJMedicare PIN