Healthcare Provider Details

I. General information

NPI: 1265727580
Provider Name (Legal Business Name): JOHN WAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 E MAIN ST STE 215
WESTMINSTER MD
21157-5037
US

IV. Provider business mailing address

684 POOLE RD STE A
WESTMINSTER MD
21157-6173
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-8104
  • Fax:
Mailing address:
  • Phone: 667-367-2260
  • Fax: 410-848-5629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0077578
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: