Healthcare Provider Details

I. General information

NPI: 1467944777
Provider Name (Legal Business Name): STEPHANIE MARGARET WONG MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCGILL UNIVERSITY HEALTH CENTRE - GENERAL SURGERY 1650 CEDAR AVE, L9.424
MONTREAL QUEBEC
H3G 1A4
CA

IV. Provider business mailing address

64 ST PAUL O APT 402
MONTREAL QUEBEC
248
CA

V. Phone/Fax

Practice location:
  • Phone: 514-934-1934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number274174
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: