Provider Demographics
NPI: | 1710966445 |
---|---|
Name: | WANG, JINSONG (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | JINSONG |
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: | 17 RIVERSIDE ST |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | NASHUA |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03062-1304 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-883-0091 |
Mailing Address - Fax: | 603-881-3739 |
Practice Address - Street 1: | 700 LAKE AVE |
Practice Address - Street 2: | SUITE ONE |
Practice Address - City: | MANCHESTER |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03103-2734 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-883-0091 |
Practice Address - Fax: | 603-881-3739 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-11 |
Last Update Date: | 2024-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NH | 10922 | 207XS0106X, 207X00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | |
No | 207XS0106X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 30201006 | Medicaid | |
NH | 30201006 | Medicaid | |
NH | H03032 | Medicare UPIN | |
NH | 0389700001 | Medicare NSC |