Healthcare Provider Details

I. General information

NPI: 1114570512
Provider Name (Legal Business Name): MARY TIEN-YI WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # NA23
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # NA23
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2200
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax: 216-444-2397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.145597
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57.248052
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: