Basic Information
| Provider Information | |||||||||
| NPI: | 1528051257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | XIN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 LAWN AVE | ||||||||
| Address2: | THE SUMMIT - SUITE 5 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152574900 | ||||||||
| FaxNumber: | 2152576681 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 LAWN AVE | ||||||||
| Address2: | THE SUMMIT - SUITE 5 | ||||||||
| City: | SELLERSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189601560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152574900 | ||||||||
| FaxNumber: | 2152576681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | MD418769 | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0019012710001 | 05 | PA | MEDICAID |