Provider Demographics
NPI:1760513097
Name:HONG, MINDY M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:M
Last Name:HONG
Suffix:
Gender:F
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:PO BOX 70626
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20813-0626
Mailing Address - Country:US
Mailing Address - Phone:301-656-6700
Mailing Address - Fax:301-656-6701
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 1455
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-6700
Practice Address - Fax:301-656-6701
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000746C60Medicare ID - Type Unspecified