Healthcare Provider Details

I. General information

NPI: 1003745514
Provider Name (Legal Business Name): MICHAEL WONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 SCHOENERSVILLE RD
BETHLEHEM PA
18017-7300
US

IV. Provider business mailing address

1406 S 15TH ST
PHILADELPHIA PA
19146-4804
US

V. Phone/Fax

Practice location:
  • Phone: 610-751-8253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT237162
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: