Healthcare Provider Details

I. General information

NPI: 1770588923
Provider Name (Legal Business Name): GENE WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MALL RD
BURLINGTON MA
01805
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8780
  • Fax: 781-744-1579
Mailing address:
  • Phone: 781-744-8780
  • Fax: 781-744-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number242294
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: