Provider Demographics
NPI:1912988486
Name:WANG, KATHERINE KE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KE
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:DOB 316
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-497-6058
Mailing Address - Fax:
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:DOB 316
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-497-6058
Practice Address - Fax:617-499-5441
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA210278207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0134805Medicaid
MAH43044Medicare UPIN
MA0134805Medicaid