Provider Demographics
NPI:1023006129
Name:TONG, ROLANDO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:M
Last Name:TONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:2215 STATE RD 17
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0668
Mailing Address - Country:US
Mailing Address - Phone:575-756-1030
Mailing Address - Fax:575-756-1030
Practice Address - Street 1:2215 STATE RD 17
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0668
Practice Address - Country:US
Practice Address - Phone:575-756-1030
Practice Address - Fax:575-756-1030
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E1435Medicaid
333403401Medicare PIN
B68751Medicare UPIN