Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 2014006548 | MO |
Y | 204F00000X | Transplant Surgeon | D0069174 | MD |
N | 208200000X | Surgeon | 2014006548 | MO |
N | 208600000X | Surgeon | 2014006548 | MO |
NPI | 1649324641 |
---|---|
Provider Name | Dr. Jacqueline Mary Garonzik Wang |
First Address | Baltimore, MD 21205-2109 |
Second Address | Baltimore, MD 21205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 10/08/2018 |