Provider Demographics
NPI:1629873500
Name:WAN, ERIC LEE
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LEE
Last Name:WAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 N QUEEN ST UNIT 911
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3931
Mailing Address - Country:US
Mailing Address - Phone:240-899-1181
Mailing Address - Fax:
Practice Address - Street 1:3900 RESERVOIR RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2126
Practice Address - Country:US
Practice Address - Phone:202-687-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-15
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program