Individual
MARY WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6780 MAYFIELD RD, MAYFIELD HTS, OH 44124-2203
(216) 449-4500
Mailing address
2801 MARTIN LUTHER KING JR DR, CR-11, CLEVELAND, OH 44104-3815
(216) 448-6254
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.078204
OH
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
35.078204
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2216444
—
OH
01
—
942460636468
CARESOURCE
OH
Enumeration date
06/01/2006
Last updated
03/31/2016
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