Healthcare Provider Details

I. General information

NPI: 1689135501
Provider Name (Legal Business Name): WILLIAM THOMAS WING DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8630 FENTON ST STE 122
SILVER SPRING MD
20910-3803
US

IV. Provider business mailing address

8630 FENTON ST STE 122
SILVER SPRING MD
20910-3803
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-0057
  • Fax: 301-588-0014
Mailing address:
  • Phone: 301-588-0057
  • Fax: 301-588-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberH0099589
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: