Provider Demographics
NPI:1932429891
Name:ONG, ERWYN CHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:ERWYN
Middle Name:CHUA
Last Name:ONG
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:4100 HIGH RESORT BLVD SE
Practice Address - Street 2:PMG RIO RANCHO HIGH RESORT 4100
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-5901
Practice Address - Country:US
Practice Address - Phone:505-559-6400
Practice Address - Fax:505-462-8538
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2015-07-21
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NMMD2014-0824207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM414862YS5YMedicare PIN