Healthcare Provider Details

I. General information

NPI: 1316188162
Provider Name (Legal Business Name): GWO JAW WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2009
Last Update Date: 03/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 RAY C HUNT DRIVE UVA ORTHOPAEDIC CENTER AT FONTAINE
CHARLOTTESVILLE VA
22906
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-5432
  • Fax: 434-243-5075
Mailing address:
  • Phone: 434-295-1000
  • Fax: 434-972-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101025663
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: