MEDICARE: BO WANG

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	247ZC0005X	Clinical Laboratory Director (Non-physician)

General Provider Information

NPI Number	:	1285258970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BO WANG

Provider Business Mailing Address
First Line	:	1 CENTURIAN DR STE 103
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CENTURIAN DR STE 103
Second Line	:
City	:	NEWARK
State	:	DE
Zip	:	19713-2154
Country	:	US
Telephone Number	:	302-407-5903
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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Directions to “ BO WANG ” Practice Location

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