Individual
DR. JAY G. FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE NORTH, WORCESTER, MA 01655
(774) 441-8082
(774) 441-8056
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
230289
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110075071A
—
MA
Enumeration date
10/18/2006
Last updated
11/09/2020
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