Provider Demographics
NPI:1871941971
Name:GONG, LINDA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:GONG
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CHENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:277 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6708
Mailing Address - Country:US
Mailing Address - Phone:781-912-2500
Mailing Address - Fax:
Practice Address - Street 1:277 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6708
Practice Address - Country:US
Practice Address - Phone:781-912-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316029363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics