Provider Demographics
NPI:1871594507
Name:WANG, LINDA M (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 715118
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5118
Mailing Address - Country:US
Mailing Address - Phone:330-263-8428
Mailing Address - Fax:330-263-8190
Practice Address - Street 1:128 E MILLTOWN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-6109
Practice Address - Country:US
Practice Address - Phone:330-202-3353
Practice Address - Fax:330-202-3428
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35077793W208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34181853100OtherWORKERS COMP GROUP
OH2173197Medicaid
OHL2173197Medicaid
341818531LWOtherSUMMACARE INC
000000139731OtherANTHEM BCBS
OHA018051Medicare ID - Type Unspecified
000000139731OtherANTHEM BCBS