Individual
DR. CHUN JU WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2401 W BELVEDERE AVE, DEPT OF REHAB MEDICINE, BALTIMORE, MD 21215-5216
(410) 601-5906
(410) 601-6071
Mailing address
2401 W BELVEDERE AVE, CREDENTIALING, BALTIMORE, MD 21215-5216
(410) 601-5523
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
11167
MT
208100000X
Physical Medicine & Rehabilitation Physician
Primary
H0068125
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036108057
—
IL
01
—
CA8374
R/R MEDICARE GROUP PTAN
MD
01
—
P00846986
R/R MEDICARE PTAN
MD
Enumeration date
08/05/2006
Last updated
10/15/2010
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