Individual
FAN GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 OLD YORK RD, CHIEF OF STAFF OFFICE, ABINGTON, PA 19001
(215) 481-2334
(215) 481-4074
Mailing address
4 MOCCASIN TRL, MEDIA, PA 19063-4721
(412) 608-0245
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
SP021209
PA
363L00000X
Nurse Practitioner
Primary
SP021209
PA
Other
Enumeration date
11/26/2019
Last updated
02/26/2020
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