MEDICARE: DR. RONG MAO M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MAOXR1	NY

General Provider Information

NPI Number	:	1679647770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONG MAO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 581054
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84158-1054
Country	:	US
Telephone Number	:	801-213-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1221
Country	:	US
Telephone Number	:	801-581-2507
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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