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:
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Health care specialties

SpecialtyCodeLicense #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 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790006773 NPPES
Massachusetts MEDICAID 110110902A

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