Provider Demographics
NPI:1346335205
Name:FONG, STEVEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:710 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1029
Mailing Address - Country:US
Mailing Address - Phone:240-281-3245
Mailing Address - Fax:301-576-4576
Practice Address - Street 1:710 HARRINGTON RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1029
Practice Address - Country:US
Practice Address - Phone:240-281-3245
Practice Address - Fax:301-576-4576
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060052207Q00000X
VA0101242060207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH89230Medicare UPIN