MEDICARE: ANN MARIE DEVERAS WONG 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	208000000X	Pediatrics Physician	204659	NY
2	208000000X	Pediatrics Physician	ME 108078	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093704769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN MARIE DEVERAS WONG M.D.

Provider Business Mailing Address
First Line	:	375 NE 54TH ST STE 7
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-2966
Country	:	US
Telephone Number	:	786-842-7001
Fax Number	:	786-410-9200

Provider Business Practice Location Address
First Line	:	1801 NE 123RD ST
Second Line	:	SUITE 414
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2817
Country	:	US
Telephone Number	:	305-981-0600
Fax Number	:	305-981-2700

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/10/2019

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