Healthcare Provider Details

I. General information

NPI: 1942629357
Provider Name (Legal Business Name): QIAN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 05/24/2021
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE # 1 ONE CHILDREN'S HOSPITAL DRIVE
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

1622 TWIN OAKS DR ONE CHILDREN'S HOSPITAL DRIVE
SEWICKLEY PA
15143-8884
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMD462977
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: