Individual
CHARLOTTE I. WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 LAKE AVE N, CRITICAL CARE MEDICINE, WORCESTER, MA 01655-0002
(774) 442-6534
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA5303
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110113244A
—
MA
Enumeration date
04/09/2015
Last updated
12/29/2020
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