Basic Information
| Provider Information | |||||||||
| NPI: | 1053494377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONG | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 537 STOCKBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054459354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8024252061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 32 N PROSPECT ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 054013338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8028470000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0201X | VT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology |
ID Information
| ID | Type | State | Issuer | Description | 0VN0383 | 05 | VT | MEDICAID | 01346381 | 05 | NY | MEDICAID |