Basic Information
| Provider Information | |||||||||
| NPI: | 1134156854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONG | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7695 SWEET HOURS WAY | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210462477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103815411 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 MAIN STREET | ||||||||
| Address2: | SUITE 351 | ||||||||
| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207074353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014985990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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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 | 207P00000X | D33983 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 532991400 | 05 | MD | MEDICAID |