# 126TH STREET MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316949787
- **Authorized official:** DR. VICTOR GONG MD (MEDICAL OFFICER)
- **Authorized official phone:** (410) 250-8000

## Contact information

- **Practice address:** 12601 D COASTAL HIGHWAY, OCEAN CITY, MD 21842-9784
- **Practice address phone:** (410) 250-8000
- **Practice address fax:** (410) 250-1308
- **Mailing address:** 12601 D COASTAL HIGHWAY, OCEAN CITY, MD 21842-9784
- **Mailing address phone:** (410) 250-8000
- **Mailing address fax:** (410) 250-1308

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D0032615 | MD | Yes |

## Other

- **Enumeration date:** 08/15/2005
- **Last updated:** 08/22/2020