Healthcare Provider Details

I. General information

NPI: 1780338277
Provider Name (Legal Business Name): SONGPING WANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 DEVEREAUX TER
NORTH POTOMAC MD
20878-4331
US

IV. Provider business mailing address

14600 DEVEREAUX TER
NORTH POTOMAC MD
20878-4331
US

V. Phone/Fax

Practice location:
  • Phone: 301-518-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberM05401
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM05401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: