Provider Demographics
NPI:1942279518
Name:WONG, ALBERT KINTIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:KINTIM
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KINTIM
Other - Middle Name:ALBERT
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5500 KNOLL NORTH DR STE 490
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2380
Mailing Address - Country:US
Mailing Address - Phone:410-964-1200
Mailing Address - Fax:410-964-1002
Practice Address - Street 1:5500 KNOLL NORTH DR STE 490
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2380
Practice Address - Country:US
Practice Address - Phone:410-964-1200
Practice Address - Fax:410-964-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025635207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD301231000Medicaid
MD301231000Medicaid
MD301231000Medicaid