Healthcare Provider Details

I. General information

NPI: 1043205974
Provider Name (Legal Business Name): CATHY D CHONG M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 MAIN ST
WEYMOUTH MA
02190-1659
US

IV. Provider business mailing address

825 MAIN ST
WEYMOUTH MA
02190-1659
US

V. Phone/Fax

Practice location:
  • Phone: 781-337-3424
  • Fax: 781-337-7569
Mailing address:
  • Phone: 781-337-3424
  • Fax: 781-337-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number159675
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: