Basic Information
| Provider Information | |||||||||
| NPI: | 1952362816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOANG | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 534595 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303534595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317258300 | ||||||||
| FaxNumber: | 3217251555 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 SAN FILIPPO DR SE | ||||||||
| Address2: | |||||||||
| City: | PALM BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329092200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217258300 | ||||||||
| FaxNumber: | 3217251555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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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 | 207RH0003X | ME73490 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 830007452 | 01 | RAIL ROAD MEDICARE | OTHER | 261560600 | 05 | FL | MEDICAID |