Provider Demographics
NPI:1740418466
Name:WONG, ALAN C (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:C
Last Name:WONG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CONGRESS ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0927
Mailing Address - Country:US
Mailing Address - Phone:617-471-0033
Mailing Address - Fax:617-471-5438
Practice Address - Street 1:500 CONGRESS ST STE 3A
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0927
Practice Address - Country:US
Practice Address - Phone:617-471-0033
Practice Address - Fax:617-471-5438
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60093599207R00000X
IL036.129733207RG0100X
RIMD14911207RG0100X
MA269244207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine