Provider Demographics
NPI:1851491476
Name:NG-WAGNER, SIU TING (MD)
Entity Type:Individual
Prefix:DR
First Name:SIU TING
Middle Name:
Last Name:NG-WAGNER
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 1:14955 SHADY GROVE RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8700
Mailing Address - Country:US
Mailing Address - Phone:301-340-1495
Mailing Address - Fax:301-838-9712
Practice Address - Street 1:14955 SHADY GROVE RD
Practice Address - Street 2:SUITE 125
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8700
Practice Address - Country:US
Practice Address - Phone:301-340-1495
Practice Address - Fax:301-838-9712
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46493207VE0102X, 207VG0400X
DCMD21075207VE0102X, 207VG0400X
VA0101051314207VE0102X, 207VG0400X
CAG66514207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Not Answered207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70468Medicare UPIN