Healthcare Provider Details

I. General information

NPI: 1114128204
Provider Name (Legal Business Name): PETER S WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARNIE BLVD STE B5
VOORHEES NJ
08043-4514
US

IV. Provider business mailing address

400 FELLOWSHIP RD STE 200
MOUNT LAUREL NJ
08054-3437
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-7572
  • Fax:
Mailing address:
  • Phone: 856-229-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA13004300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberMD442315
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: