Healthcare Provider Details

I. General information

NPI: 1154576841
Provider Name (Legal Business Name): ALVIN N WANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

135 FAIRVIEW RD
PENN VALLEY PA
19072-1330
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax:
Mailing address:
  • Phone: 215-688-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOT12242
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS015076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: