Individual
ALICE M WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
840 HARRISON AVE, MENINO 3, BOSTON, MA 02118-2905
(617) 414-5471
(617) 414-4358
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
229262
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110081566A
—
MA
Enumeration date
07/13/2006
Last updated
07/10/2014
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