Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD455923 | PA |
Y | 111NI0900X | Internist | MD455923 | PA |
NPI | 1003253691 |
---|---|
Provider Name | Daniel Wang |
First Address | Wynnewood, PA 19096-3450 |
Second Address | Wynnewood, PA 19096-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2013 |
Last Update Date | 31/08/2016 |