Peng Ethan Wang, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34011186 Issued in OH

Practice address

7675 Wellness Way
West Chester, OH 45069-2509

Phone

(513) 475-7700

NPI assigned

Jun 30, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1309392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626393600000",
    "number": "1720375587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 VICTORY PARKWAY",
            "address_2": "PAYOR ENROLLMENT",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452061785",
            "telephone_number": "513-585-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7675 WELLNESS WAY",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692509",
            "telephone_number": "513-475-7700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9403 Kenwood Rd Ste D203",
            "address_purpose": "LOCATION",
            "city": "Blue Ash",
            "state": "OH",
            "postal_code": "452426878",
            "country_code": "US",
            "telephone_number": "513-686-8100",
            "fax_number": "513-686-8109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9403 Kenwood Rd Ste D203",
            "address_purpose": "LOCATION",
            "city": "Blue Ash",
            "state": "OH",
            "postal_code": "452426878",
            "country_code": "US",
            "telephone_number": "513-686-8100",
            "fax_number": "513-686-8109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WANG",
        "first_name": "PENG",
        "middle_name": "ETHAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-30",
        "last_updated": "2021-07-16",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34011186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0105815",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Frances Waltz, M.A., CCC
• Ian Walz, CDCA
• Sylvie Wamba
• Chengxi Wang, MD
• Megan Wang, PHARMD
• Shanhong Wang
• Gina Ward
• Sharon Romaine Ward, CNP
• Wargo Counseling & Consultation
• Kelsey Wargo, LPC

• Internal Medicine Physician in West Chester, OH
• Providers in West Chester, OH by specialty
• Internal Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.