Healthcare Provider Details

I. General information

NPI: 1952983397
Provider Name (Legal Business Name): JAREY HAO WANG MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST STE 1440
BALTIMORE MD
21287-0019
US

IV. Provider business mailing address

4512 KINGSCUP CT
ELLICOTT CITY MD
21042-5976
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-8000
  • Fax:
Mailing address:
  • Phone: 484-467-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberD0107124
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: