Healthcare Provider Details

I. General information

NPI: 1265540462
Provider Name (Legal Business Name): MERRY BETH GONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2344 6TH ST
BERKELEY CA
94710-2412
US

IV. Provider business mailing address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-3203
  • Fax: 510-553-2169
Mailing address:
  • Phone: 510-601-6060
  • Fax: 510-428-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberG32302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: