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General NPI Number Information
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NPI Number | 1295120723
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Entity Type | Individual
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Provider Name | ASHLEY WONGK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 2950 VILLAGE DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4128
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Country | US
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Telephone | 910-323-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 2041 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20060-0001
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Country | US
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Telephone |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2019-01525
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License Number State | NC
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