Provider Demographics
NPI:1942562004
Name:CHONG, MERCY (MD)
Entity type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:CHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MERCY
Other - Middle Name:
Other - Last Name:CHUAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 N MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-2100
Mailing Address - Country:US
Mailing Address - Phone:937-762-5500
Mailing Address - Fax:937-762-5099
Practice Address - Street 1:825 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-2100
Practice Address - Country:US
Practice Address - Phone:937-762-5500
Practice Address - Fax:937-762-5099
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50457208000000X
IN01079020A208000000X
OH35.131778208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255509Medicaid