=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831261783
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EDMON WANG LIM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 08/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MOUNT VERNON HOSPITAL 2501 PARKERS LANE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-855-6889
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4614 HOLLY AVE
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-5627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-385-1813
-----------------------------------------------------
Fax | 703-385-4505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101035379
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------