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General NPI Number Information
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NPI Number | 1245520907
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Entity Type | Organization
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Legal Business Name | GLORIA C FONG, M.D., INC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 530 SCHOOLHOUSE RD SUITE G
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City | HOCKESSIN
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State | DE
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Zip | 19707-9526
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Country | US
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Telephone | 302-239-6282
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Fax | 302-239-6458
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Provider Business Mailing Address
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Address Line | 530 SCHOOLHOUSE RD SUITE G
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City | HOCKESSIN
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State | DE
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Zip | 19707-9526
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Country | US
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Telephone | 302-239-6282
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Fax | 302-239-6458
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLORIA C FONG
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Credential | M.D.
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Telephone | 302-239-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C10002395
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License Number State | DE
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