Healthcare Provider Details

I. General information

NPI: 1326215690
Provider Name (Legal Business Name): GUOFANG WANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E CHESTER PIKE
RIDLEY PARK PA
19078-2212
US

IV. Provider business mailing address

2602 W 9TH ST
CHESTER PA
19013-2040
US

V. Phone/Fax

Practice location:
  • Phone: 610-595-6586
  • Fax: 610-595-6787
Mailing address:
  • Phone: 610-497-7548
  • Fax: 610-497-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD437798
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116019620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: