Healthcare Provider Details

I. General information

NPI: 1104843887
Provider Name (Legal Business Name): WAYNE HWANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MEDICAL PARK DRIVE SUITE 3
SILVER SPRING MD
20902
US

IV. Provider business mailing address

4718 CARR DRIVE PER SE TECHNOLOGIES ELLIE CONLEY
FREDERICKSBURG VA
22408
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-3003
  • Fax: 301-681-5868
Mailing address:
  • Phone: 540-891-5764
  • Fax: 540-891-5769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0063503
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: