Provider Demographics
NPI:1194977603
Name:GONG, ZHAODI (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ZHAODI
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2510
Mailing Address - Country:US
Mailing Address - Phone:203-557-3331
Mailing Address - Fax:203-557-6688
Practice Address - Street 1:125 KINGS HWY N
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2428
Practice Address - Country:US
Practice Address - Phone:203-557-3331
Practice Address - Fax:203-557-6688
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139312207LP2900X
CT52543207LP2900X
CA131548207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine