Basic Information
| Provider Information | |||||||||
| NPI: | 1467434308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MEMORIAL AVE | ||||||||
| Address2: | CARROLL HOSPITAL CENTER | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108483000 | ||||||||
| FaxNumber: | 4108716325 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 MEMORIAL AVE | ||||||||
| Address2: | CARROLL HOSPITAL CENTER | ||||||||
| City: | WESTMINSTER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211575726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108483000 | ||||||||
| FaxNumber: | 4108716325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0001879 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.