Healthcare Provider Details

I. General information

NPI: 1639162969
Provider Name (Legal Business Name): MICHAEL C ONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LONGFELLOW ST SUITE 200
VANDERGRIFT PA
15690-1476
US

IV. Provider business mailing address

224 LONGFELLOW ST SUITE 200
VANDERGRIFT PA
15690-1476
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-5551
  • Fax: 724-568-3137
Mailing address:
  • Phone: 724-568-5551
  • Fax: 724-568-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD066489-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: