MEDICARE: DR. WENDY 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	207Q00000X	Family Medicine Physician	036110440	ID

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
2	01621679	OTHER	IL	BCBS OF IL

General Provider Information

NPI Number	:	1184600801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY WONG M.D.

Provider Business Mailing Address
First Line	:	2101 MEDICAL PARK DR
Second Line	:	#308
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4053
Country	:	US
Telephone Number	:	301-681-8000
Fax Number	:	301-681-8567

Provider Business Practice Location Address
First Line	:	2101 MEDICAL PARK DR
Second Line	:	#308
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4053
Country	:	US
Telephone Number	:	301-681-8000
Fax Number	:	301-681-8567

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

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	11/17/2022

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