Provider Demographics
NPI:1205982162
Name:GAO, HONG GUANG (MD)
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:GUANG
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:254 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-1766
Mailing Address - Country:US
Mailing Address - Phone:732-745-8964
Mailing Address - Fax:856-488-6848
Practice Address - Street 1:254 EASTON AVE.
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-0890
Practice Address - Country:US
Practice Address - Phone:856-488-6560
Practice Address - Fax:856-488-6848
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08423500207ZC0500X, 207ZC0006X, 207ZP0102X
PAMT187988207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00709956OtherRR MCR
NJP00807260OtherRAILROAD MEDICARE
NJ0189626Medicaid
NJ0189626Medicaid
NJP00709956OtherRR MCR