Provider Demographics
NPI:1235140799
Name:WANG, PANGHSUNG (MD)
Entity type:Individual
Prefix:DR
First Name:PANGHSUNG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4633
Mailing Address - Country:US
Mailing Address - Phone:203-878-1006
Mailing Address - Fax:203-878-7043
Practice Address - Street 1:2044 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4633
Practice Address - Country:US
Practice Address - Phone:203-878-1006
Practice Address - Fax:203-878-7043
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT016645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1166453Medicaid
CT1166453Medicaid
CT060000080Medicare ID - Type Unspecified