Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A97865 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | 25MA08750000 | NJ |
Y | 207XS0106X | Orthopaedic Hand Surgeon | MD439395 | PA |
NPI | 1043467384 |
---|---|
Provider Name | Mark Ly Wang |
First Address | Philadelphia, PA 19107-4414 |
Second Address | Philadelphia, PA 19107-4216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 10/11/2015 |