Healthcare Provider Details

I. General information

NPI: 1568476059
Provider Name (Legal Business Name): CHARLES WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHI-LUN WANG MD,PA

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WAWASET ST STE 200
WILMINGTON DE
19806-2142
US

IV. Provider business mailing address

1700 WAWASET ST STE 200
WILMINGTON DE
19806-2142
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-1500
  • Fax: 302-655-4084
Mailing address:
  • Phone: 302-655-1500
  • Fax: 302-655-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberC10002450
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD023090E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA06195500
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberC10002450
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: