MEDICARE: DR. JOHN K FONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	MD034323E	PA

General Provider Information

NPI Number	:	1073591145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN K FONG MD

Provider Business Mailing Address
First Line	:	120 5TH AVE
Second Line	:	SUITE P4501
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3000
Country	:	US
Telephone Number	:	412-544-2886
Fax Number	:	412-544-2619

Provider Business Practice Location Address
First Line	:	120 5TH AVE
Second Line	:	SUITE P4501
City	:	PITTSBURGH
State	:	PA
Zip	:	15222-3000
Country	:	US
Telephone Number	:	412-544-2886
Fax Number	:	412-544-2619

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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