Healthcare Provider Details

I. General information

NPI: 1013478262
Provider Name (Legal Business Name): JUDY WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 UNION ST
MARLBOROUGH MA
01752-1228
US

IV. Provider business mailing address

119 BELMONT STREET
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-486-5678
  • Fax: 508-486-5677
Mailing address:
  • Phone: 508-334-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD95399
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number290340
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: