Provider Demographics
NPI:1013170406
Name:MING T WONG MD PC
Entity Type:Organization
Organization Name:MING T WONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MING
Authorized Official - Middle Name:TAT
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-254-5805
Mailing Address - Street 1:39 BRIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2301
Mailing Address - Country:US
Mailing Address - Phone:617-254-5805
Mailing Address - Fax:617-254-7118
Practice Address - Street 1:39 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2301
Practice Address - Country:US
Practice Address - Phone:617-254-5805
Practice Address - Fax:617-254-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty