Provider Demographics
NPI:1730273301
Name:WANG, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
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 1:3871 HARLEM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1946
Mailing Address - Country:US
Mailing Address - Phone:716-836-7510
Mailing Address - Fax:716-832-3540
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-836-7510
Practice Address - Fax:716-832-3540
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209264-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01857836Medicaid
NYBB1660Medicare ID - Type Unspecified
NY01857836Medicaid