Provider Demographics
NPI:1295763647
Name:CHI S WANG MD
Entity type:Organization
Organization Name:CHI S WANG MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD & OWNER OF PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:CHI
Authorized Official - Middle Name:SHIANG
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-453-1300
Mailing Address - Street 1:133 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852
Mailing Address - Country:US
Mailing Address - Phone:978-453-1300
Mailing Address - Fax:978-441-0825
Practice Address - Street 1:20 HOPE AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-891-1230
Practice Address - Fax:781-893-7138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34072207KA0200X, 208000000X, 208D00000X
MA36270207KA0200X
MA53478208D00000X
MA51559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M15313OtherBC
MA9764704Medicaid
E35806Medicare UPIN
E02027Medicare UPIN
A57174Medicare UPIN
M15313Medicare ID - Type Unspecified
MA9764704Medicaid