Individual provider Active NPI

Leo L Wang, MD, PHD

  • Dermatology Physician
  • Philadelphia, PA
National Provider Identifier
1548898372
Registry record updated Mar 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD480709 Issued in PA
Practice address
3400 Civic Center Blvd
1-330S Perelman Center
Philadelphia, PA 19104-5127
Phone
(215) 662-2737
Fax
(215) 615-3424
NPI assigned
Mar 28, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X MD480709 PA Primary

Addresses

Primary practice location

3400 Civic Center Blvd
1-330S Perelman Center
Philadelphia, PA 19104-5127

Mailing address

3400 Civic Center Blvd
1-330S Perelman Center
Philadelphia, PA 19104-5127
Phone (215) 662-2737

Other practice location 1

3600 Spruce St
Philadelphia, PA 19104-4211
Phone (215) 662-7883

Other practice location 2

1122 Street Rd Ste 204
Southampton, PA 18966-4218
Phone (215) 999-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240603000209 PA Practitioner - Dermatology 5092257311 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Specialists of PennsylvaniaGroup PAC ID 4284051079, 5 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1122 St Rd
Suite 204
Southampton, PA 18966-4218
Phone (215) 999-7546

3400 Civic Ctr Blvd
Suite 1 330S
Philadelphia, PA 19104-5132
Phone (215) 662-2737

Hospital & facility affiliations

  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision21
Removal of skin lesions426
Removal of skin cancer1-10
Removal or shaving of skin growth95
Skin biopsy42

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
MD480709PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Specialists of Pennsylvania Dermatology CurrentSince Jun 1, 2024 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 15, 2024 Accepting new patients
University of Penn-Medical Group CurrentSince Jul 15, 2024 Accepting new patients
University of Penn - Medical Group PastSince Apr 23, 2023 Accepting new patients

Locations

3400 Convention Ave
Philadelphia, PA 19104
Phone (215) 662-2300

3400 Civic Center Blvd
Ste 1-330S
Philadelphia, PA 19104
Phone (215) 360-0909

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

1122 Street Rd
Ste 204
Southampton, PA 18966
Phone (215) 949-3100

800 Spruce St
William Penn Annex West, PA 19107
Phone (215) 829-3867

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1585353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772755200000",
    "number": "1548898372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1-330S PERELMAN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2737",
            "fax_number": "215-615-3424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "address_2": "1-330S PERELMAN CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191045127",
            "telephone_number": "215-662-2737",
            "fax_number": "215-615-3424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Spruce St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044211",
            "country_code": "US",
            "telephone_number": "215-662-7883",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1122 Street Rd Ste 204",
            "address_purpose": "LOCATION",
            "city": "Southampton",
            "state": "PA",
            "postal_code": "189664218",
            "country_code": "US",
            "telephone_number": "215-999-7546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "LEO",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-28",
        "last_updated": "2026-03-06",
        "certification_date": "2026-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD480709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.