Healthcare Provider Details

I. General information

NPI: 1144420894
Provider Name (Legal Business Name): DAVID C WANG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST SUITE 300
MC LEAN VA
22101-3884
US

IV. Provider business mailing address

6829 ELM ST SUITE 300
MC LEAN VA
22101-3884
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax: 703-237-3105
Mailing address:
  • Phone: 703-532-4892
  • Fax: 703-237-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0102202745
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberL231462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: