Provider Demographics
NPI:1972910214
Name:WONG, MICHAEL SENG CHUNG
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SENG CHUNG
Last Name:WONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 LATROBE FLS
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-6613
Mailing Address - Country:US
Mailing Address - Phone:443-604-5392
Mailing Address - Fax:
Practice Address - Street 1:11160 VEIRS MILL RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2538
Practice Address - Country:US
Practice Address - Phone:301-946-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist