MEDICARE: STEPHANIE C.Y. TONG ATC

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	2255A2300X	Athletic Trainer	0126001828	VA
2	2255A2300X	Athletic Trainer	A0000426	MD

General Provider Information

NPI Number	:	1588906903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE C.Y. TONG ATC

Provider Business Mailing Address
First Line	:	6800 MARLBORO PIKE
Second Line	:
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-3238
Country	:	US
Telephone Number	:	301-735-8401
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 MARLBORO PIKE
Second Line	:
City	:	FORESTVILLE
State	:	MD
Zip	:	20747-3238
Country	:	US
Telephone Number	:	301-735-8401
Fax Number	:

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

Provider Enumeration Date	:	03/24/2013
Last Update Date	:	01/28/2015

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