Provider Demographics
NPI:1205861028
Name:TONG, PATRICK (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:TONG
Suffix:
Gender:M
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 1:7120 MINSTREL WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5248
Mailing Address - Country:US
Mailing Address - Phone:410-309-3399
Mailing Address - Fax:410-309-6886
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5274
Practice Address - Country:US
Practice Address - Phone:410-309-3399
Practice Address - Fax:410-309-6886
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE65818Medicare UPIN
MDKR84598NMedicare ID - Type Unspecified