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General NPI Number Information
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NPI Number | 1114128204
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Entity Type | Individual
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Provider Name | PETER S WANG MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E OLNEY AVE SUITE 400
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City | PHILADELPHIA
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State | PA
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Zip | 19120-2421
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Country | US
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Telephone | 215-456-7000
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Fax |
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | MD442315
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License Number State | PA
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