Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 34072 | MA |
N | 208000000X | Pediatrician | 34072 | MA |
N | 208D00000X | General Practice Physician | 34072 | MA |
NPI | 1518936772 |
---|---|
Provider Name | Chi Shiang Wang |
First Address | Lowell, MA 01852 |
Second Address | Waltham, MA 02453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0157201 | (05) | MA |
E02027 | (02) |