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General NPI Number Information
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NPI Number | 1053802454
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Entity Type | Individual
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Provider Name | MARY WING SUM TAM MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 57 NORTH ST STE 415
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City | DANBURY
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State | CT
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Zip | 06810-5629
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Country | US
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Telephone | 203-628-4995
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Fax |
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Provider Business Mailing Address
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Address Line | 57 NORTH ST STE 415
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City | DANBURY
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State | CT
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Zip | 06810-5629
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Country | US
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Telephone |
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Fax | 203-628-4995
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | T6053
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 80895
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME163116
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 275696
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 960492
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License Number State | NY
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