Provider Demographics
NPI:1184600801
Name:WONG, WENDY (MD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:WONG
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 1:2101 MEDICAL PARK DR
Mailing Address - Street 2:#308
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4053
Mailing Address - Country:US
Mailing Address - Phone:301-681-8000
Mailing Address - Fax:301-681-8567
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:#308
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-681-8000
Practice Address - Fax:301-681-8567
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID036110440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036110440 / 01Medicaid
IL01621679OtherBCBS OF IL
ILK 18229Medicare ID - Type UnspecifiedGROUP 950150
IL036110440 / 01Medicaid