Wong, Kaitlyn Elizabeth Ellis
Wong, Kaitlyn Elizabeth Ellis is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Pediatric Surgery. Allopathic & Osteopathic Physicians / Pediatric Surgery is her primary health care specialty. Wong, Kaitlyn Elizabeth Ellis can be contacted via phone (508) 856-2138.Contact Information
Primary practice address
55 Lake Ave N
Worcester MA 01655-0002
Phone: (508) 856-2138
Fax: (774) 443-2043
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 287610 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatric Surgery | 2086S0120X | 287610 | Massachusetts |
Profile Details
| NPI number | 1790006773 |
|---|---|
| LBN Legal business name | Wong, Kaitlyn Elizabeth Ellis |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 14th, 2010 |
| Last updated | Dec 6th, 2023 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790006773 | NPPES |
| Massachusetts | MEDICAID | 110110902A |
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