Provider Demographics
NPI:1700847712
Name:PONG, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:PONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-282-2655
Mailing Address - Fax:804-672-4948
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-282-2655
Practice Address - Fax:804-672-4948
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2014-06-23
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Provider Licenses
StateLicense IDTaxonomies
VA0101050117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
015244P63Medicare PIN
VAF76057Medicare UPIN