Provider Demographics
NPI:1225546419
Name:THONG, GERARD (MB, BCH, BAO, MCH,)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:
Last Name:THONG
Suffix:
Gender:M
Credentials:MB, BCH, BAO, MCH,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HEREFORD ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF OTOLARYNGOLOGY, BOSTON CHILDRENS HOSPITAL
Practice Address - Street 2:330 LONGWOOD AVENUE, BCH 3129
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-5064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273578207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology