Provider Demographics
NPI:1679544647
Name:WANG, JUNJIE (MD)
Entity type:Individual
Prefix:
First Name:JUNJIE
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 808
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-399-7451
Mailing Address - Fax:757-399-1158
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:MARYVIEW MEDICAL CENTER
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-399-7451
Practice Address - Fax:757-399-1158
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236595207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I13638Medicare UPIN
VA005068P79Medicare ID - Type Unspecified