Individual
KAITLYN ELIZABETH ELLIS WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-2138
(774) 443-2043
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
287610
MA
2086S0120X
Pediatric Surgery Physician
Primary
287610
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110110902A
—
MA
Enumeration date
06/14/2010
Last updated
12/06/2023
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