Provider Demographics
NPI:1659482636
Name:TONG, JENNY (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N DUKE ST
Mailing Address - Street 2:BAY 49-105
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2047
Mailing Address - Country:US
Mailing Address - Phone:919-684-0660
Mailing Address - Fax:
Practice Address - Street 1:407 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2726
Practice Address - Country:US
Practice Address - Phone:919-470-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091240207R00000X, 207RE0101X
WAMD00041610207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2814780Medicaid
IN200900790Medicaid
OHTO4233421Medicare PIN