Provider Demographics
NPI:1073515276
Name:CHONG, HENRY H (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:H
Last Name:CHONG
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 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:937-316-6350
Mailing Address - Fax:937-316-6374
Practice Address - Street 1:1101 JACKSON STREET
Practice Address - Street 2:STE B
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1183
Practice Address - Country:US
Practice Address - Phone:937-316-6350
Practice Address - Fax:937-316-6374
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070533A207RC0000X
OH35-07-0257207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000752990OtherANTHEM, REID HOSPITAL
IN200100770Medicaid
OH0248333Medicaid
IN200100770Medicaid
OH0248333Medicaid
OH0248333Medicaid