Provider Demographics
NPI:1134474224
Name:MA, DEQIONG (MD; PHD)
Entity Type:Individual
Prefix:DR
First Name:DEQIONG
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MD; PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 POPLAR ST
Mailing Address - Street 2:CLINICAL MOLECULAR AND CYTOGENETIC LAB
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2600
Mailing Address - Country:US
Mailing Address - Phone:718-405-8387
Mailing Address - Fax:
Practice Address - Street 1:1635 POPLAR ST
Practice Address - Street 2:CLINICAL MOLECULAR AND CYTOGENETIC LAB
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2600
Practice Address - Country:US
Practice Address - Phone:718-405-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program