MEDICARE: WALTER Q WANG 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	207W00000X	Ophthalmology Physician	226224	MA
2	207W00000X	Ophthalmology Physician	0101234485	VA
3	207W00000X	Ophthalmology Physician	MD037768	DC
4	207W00000X	Ophthalmology Physician	D0068111	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11518394	OTHER		CAQH ID

General Provider Information

NPI Number	:	1578544862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER Q WANG MD

Provider Business Mailing Address
First Line	:	611 S CARLIN SPRINGS RD
Second Line	:	SUITE 208
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1064
Country	:	US
Telephone Number	:	703-639-4455
Fax Number	:	703-462-8331

Provider Business Practice Location Address
First Line	:	611 S CARLIN SPRINGS RD
Second Line	:	SUITE 208
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1064
Country	:	US
Telephone Number	:	703-639-4455
Fax Number	:	703-462-8331

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	06/21/2011

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Directions to “ WALTER Q WANG MD” Practice Location

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