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General NPI Number Information
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NPI Number | 1851324370
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Entity Type | Individual
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Provider Name | NANCY WANG FONG MD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-7494
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Fax | 216-286-6341
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Provider Business Mailing Address
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Address Line | 3605 WARRENSVILLE CENTER RD 1ST FL,MSC9152
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City | SHAKER HTS
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State | OH
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Zip | 44122-5203
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Country | US
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Telephone | 216-286-6299
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Fax | 216-286-6341
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 35-069513
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License Number State | OH
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