Provider Demographics
NPI:1831465020
Name:FAN, WUQIANG (MD)
Entity type:Individual
Prefix:
First Name:WUQIANG
Middle Name:
Last Name:FAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2925 WILLIAM PENN HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5283
Mailing Address - Country:US
Mailing Address - Phone:610-258-1400
Mailing Address - Fax:610-258-3047
Practice Address - Street 1:2925 WILLIAM PENN HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5283
Practice Address - Country:US
Practice Address - Phone:610-258-1400
Practice Address - Fax:610-258-3047
Is Sole Proprietor?:No
Enumeration Date:2012-04-01
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD455239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030442710003Medicaid
PA424327V8GMedicare PIN