Provider Demographics
NPI:1598794406
Name:ONG, EDISON L (MD)
Entity Type:Individual
Prefix:DR
First Name:EDISON
Middle Name:L
Last Name:ONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:806 JEFFERSON TER
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-5727
Mailing Address - Country:US
Mailing Address - Phone:337-365-4945
Mailing Address - Fax:337-376-6860
Practice Address - Street 1:1009 CHARITY ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510
Practice Address - Country:US
Practice Address - Phone:337-893-3443
Practice Address - Fax:337-893-3439
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA12332R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1530301Medicaid
LA5F696Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LAG60620Medicare UPIN