1801864160 NPI number — DR. ANTHONY F. AFONG M.D.

Table of content: (NPI 1699786616)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801864160 NPI number — DR. ANTHONY F. AFONG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AFONG
Provider First Name:
ANTHONY
Provider Middle Name:
F.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801864160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11350 MCCORMICK RD.
Provider Second Line Business Mailing Address:
EXECUTIVE PLAZA 1, SUITE 501
Provider Business Mailing Address City Name:
HUNT VALLEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-841-7135
Provider Business Mailing Address Fax Number:
678-841-7123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 SW CHAMBER COURT
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34986-3413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-807-9000
Provider Business Practice Location Address Fax Number:
772-807-9087
Provider Enumeration Date:
03/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  ME77049 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: ME77049 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 174400000X , with the licence number: ME77049 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: ME77049 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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