=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841518313
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | XIAOFEI WANG M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2010
-----------------------------------------------------
Last Update Date | 09/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5770 COMMONS PARK DR.
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-0094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-445-1577
-----------------------------------------------------
Fax | 315-445-4862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 48
-----------------------------------------------------
City | DEWITT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13214-0048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-445-1577
-----------------------------------------------------
Fax | 315-445-4862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 275706
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------