Provider Demographics
NPI:1659864205
Name:FONG, AMY WAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:WAN
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:245 N 15TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-6900
Mailing Address - Fax:215-762-4231
Practice Address - Street 1:245 N 15TH ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1101
Practice Address - Country:US
Practice Address - Phone:215-762-6900
Practice Address - Fax:215-762-4231
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT215737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine