Provider Demographics
NPI:1922157999
Name:WONG, PETER WK (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WK
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 1:1031 CARE WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8425
Mailing Address - Country:US
Mailing Address - Phone:540-371-7600
Mailing Address - Fax:540-371-2046
Practice Address - Street 1:1031 CARE WAY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8425
Practice Address - Country:US
Practice Address - Phone:540-371-7600
Practice Address - Fax:540-371-2046
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010272068Medicaid
VA00W188G03Medicare ID - Type Unspecified
00W188G03Medicare PIN
VA010272068Medicaid