MEDICARE: PAMELA WANG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G77072	CA

General Provider Information

NPI Number	:	1033188602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA WANG M.D.

Provider Business Mailing Address
First Line	:	901 SAN RAMON VALLEY BLVD
Second Line	:	#130
City	:	DANVILLE
State	:	CA
Zip	:	94526-4034
Country	:	US
Telephone Number	:	925-820-6456
Fax Number	:	925-820-1134

Provider Business Practice Location Address
First Line	:	901 SAN RAMON VALLEY BLVD
Second Line	:	#130
City	:	DANVILLE
State	:	CA
Zip	:	94526-4034
Country	:	US
Telephone Number	:	925-820-6456
Fax Number	:	925-820-1134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	05/20/2008

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