Provider Demographics
NPI:1508918012
Name:ZHANG, GONGQIAO (PA-C)
Entity Type:Individual
Prefix:
First Name:GONGQIAO
Middle Name:
Last Name:ZHANG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:154-053-6510
Mailing Address - Fax:304-428-2597
Practice Address - Street 1:100 OAK LEE DR
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-4879
Practice Address - Country:US
Practice Address - Phone:304-930-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002256363A00000X
WV01492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01492OtherWEST VIRGINIA PA LICENSE
WV01492OtherWEST VIRGINIA PA LICENSE
WVZHPA36241Medicare UPIN
WVZHPA36241Medicare UPIN