Healthcare Provider Details

I. General information

NPI: 1881612901
Provider Name (Legal Business Name): VIRGINIA L WONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27100 CHARDON RD HARRINGTON HEART & VASCULAR INST
RICHMOND HTS OH
44143-1116
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-585-7035
  • Fax: 440-585-7032
Mailing address:
  • Phone: 440-585-7035
  • Fax: 440-585-7032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35-081035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: