Provider Demographics
NPI:1932227899
Name:CANTON PRIMARY CARE & HOSPITAL MEDICINE, INC..
Entity Type:Organization
Organization Name:CANTON PRIMARY CARE & HOSPITAL MEDICINE, INC..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:X
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-454-1693
Mailing Address - Street 1:4168 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2532
Mailing Address - Country:US
Mailing Address - Phone:330-454-1693
Mailing Address - Fax:330-454-1683
Practice Address - Street 1:4168 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2532
Practice Address - Country:US
Practice Address - Phone:330-454-1693
Practice Address - Fax:330-454-1683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074148W174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000329691OtherANTHEM
OH1306802376OtherNPI
OH2946834Medicaid
OH1306802376OtherNPI