Healthcare Provider Details

I. General information

NPI: 1487457404
Provider Name (Legal Business Name): CHARIS EMILY WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST SOUTH-GROUND FLOOR, RADIOLOGY RESIDENCY
CAMBRIDGE MA
02138
US

IV. Provider business mailing address

330 MOUNT AUBURN ST SOUTH-GROUND FLOOR, RADIOLOGY RESIDENCY
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5070
  • Fax: 617-499-5193
Mailing address:
  • Phone: 617-441-1610
  • Fax: 617-499-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: