MEDICARE: DR. LIM W WONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD062392L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144264763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIM W WONG MD

Provider Business Mailing Address
First Line	:	833 CHESTNUT ST
Second Line	:	SUITE 701
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4409
Country	:	US
Telephone Number	:	215-955-0735
Fax Number	:	215-503-9239

Provider Business Practice Location Address
First Line	:	833 CHESTNUT ST
Second Line	:	SUITE 701
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-4409
Country	:	US
Telephone Number	:	215-955-0735
Fax Number	:	215-503-9239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/14/2015

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Directions to “ DR. LIM W WONG MD” Practice Location

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