Healthcare Provider Details

I. General information

NPI: 1972968758
Provider Name (Legal Business Name): RYAN WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

IV. Provider business mailing address

2014 WASHINGTON ST
NEWTON MA
02462-1607
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6298
  • Fax:
Mailing address:
  • Phone: 617-243-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA178435
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1027147
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61416657
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: