Provider Demographics
NPI:1881612901
Name:WONG, VIRGINIA L (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-585-7035
Mailing Address - Fax:440-585-7032
Practice Address - Street 1:27100 CHARDON RD
Practice Address - Street 2:HARRINGTON HEART & VASCULAR INST
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1116
Practice Address - Country:US
Practice Address - Phone:440-585-7035
Practice Address - Fax:440-585-7032
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0810352086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2473621Medicaid
OH000000221416OtherUNISON
OHP00372970OtherRAILROAD MEDICARE
OH745379OtherBUCKEYE
OH745379OtherBUCKEYE
OH2473621Medicaid
I04951Medicare UPIN
OH745379OtherBUCKEYE
7482565OtherAETNA
OH000000221416OtherUNISON