Individual
ANSELM WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
281 LINCOLN ST, WORCESTER, MA 01605-2138
(508) 334-5958
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
264919
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110105588A
—
MA
Enumeration date
01/04/2007
Last updated
11/17/2020
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