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General NPI Number Information
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NPI Number | 1174974968
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Entity Type | Individual
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Provider Name | QING YU WENG M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 330 MOUNT AUBURN ST
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City | CAMBRIDGE
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State | MA
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Zip | 02138-5502
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Country | US
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Telephone | 617-492-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 50 STANIFORD ST
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City | BOSTON
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State | MA
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Zip | 02114-2517
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Country | US
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Telephone | 617-726-2000
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 283002
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 268109
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License Number State | MA
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