Provider Demographics
NPI:1912970435
Name:DONG, XIANG DA (MD)
Entity type:Individual
Prefix:DR
First Name:XIANG
Middle Name:DA
Last Name:DONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19 BRADHURST AVE
Mailing Address - Street 2:SUITE 3100N
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-2140
Mailing Address - Country:US
Mailing Address - Phone:914-909-9018
Mailing Address - Fax:914-493-2267
Practice Address - Street 1:100 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1530
Practice Address - Country:US
Practice Address - Phone:914-909-9018
Practice Address - Fax:914-493-2267
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2021-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY259782208600000X, 2086X0206X
CT45107208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY259782OtherNEW YORK STATE LICENSE
CT45107OtherCONNECTICUT LICENSE
PA092970FKYMedicare PIN
PA101325390Medicaid
I35625Medicare UPIN