MEDICARE: DR. SOPHIE WANG MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207ZD0900X	Dermatopathology (Pathology) Physician	MD.41958	AL
3	207N00000X	Dermatology Physician	MD.41958	AL

General Provider Information

NPI Number	:	1205396330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIE WANG MD

Provider Business Mailing Address
First Line	:	3415 INDEPENDENCE DR STE 200
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-8315
Country	:	US
Telephone Number	:	205-871-7332
Fax Number	:	205-871-7336

Provider Business Practice Location Address
First Line	:	3415 INDEPENDENCE DR STE 200
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-8315
Country	:	US
Telephone Number	:	205-871-7332
Fax Number	:

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

Provider Enumeration Date	:	03/24/2019
Last Update Date	:	03/03/2026

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