Provider Demographics
NPI:1013935311
Name:MONG, ALAN T (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:T
Last Name:MONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-4550
Mailing Address - Fax:
Practice Address - Street 1:4439 STATE ROUTE 159 STE 270
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-7502
Practice Address - Country:US
Practice Address - Phone:740-779-4550
Practice Address - Fax:740-779-4569
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.072711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2041990Medicaid
OHC72573Medicare UPIN
OHMO7277201Medicare ID - Type Unspecified