Healthcare Provider Details

I. General information

NPI: 1700687639
Provider Name (Legal Business Name): CRYSTAL WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

248 SHAWCROFT RD
FAYETTEVILLE NC
28311-2917
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-9262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2026-04037
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: