Healthcare Provider Details

I. General information

NPI: 1811344146
Provider Name (Legal Business Name): LILY JINLING WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

IV. Provider business mailing address

92 CAMPUS DR STE D
SCARBOROUGH ME
04074-7229
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-2087
  • Fax:
Mailing address:
  • Phone: 207-661-2087
  • Fax: 401-444-4557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP03605
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberR3811
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD27087
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: