Healthcare Provider Details

I. General information

NPI: 1982875449
Provider Name (Legal Business Name): WEIHAN WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15245 SHADY GROVE RD SUITE 130
ROCKVILLE MD
20850-3222
US

IV. Provider business mailing address

14707 YEARLING TER
ROCKVILLE MD
20850-3552
US

V. Phone/Fax

Practice location:
  • Phone: 301-527-1650
  • Fax: 301-527-8752
Mailing address:
  • Phone: 301-251-1429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0067092
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: