MEDICARE: DR. DANIEL C CHONG 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	208600000X	Surgery Physician	D0085699	MD
2	208600000X	Surgery Physician	MD-38155	IA

General Provider Information

NPI Number	:	1710914361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL C CHONG MD

Provider Business Mailing Address
First Line	:	14346 POTOMAC HEIGHTS LN
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-3844
Country	:	US
Telephone Number	:	573-310-4620
Fax Number	:

Provider Business Practice Location Address
First Line	:	14346 POTOMAC HEIGHTS LN
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-3844
Country	:	US
Telephone Number	:	573-310-4620
Fax Number	:

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	06/03/2019

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