NPIMap

Organization Active NPI

126TH Street Medical

  • Family Medicine Physician
  • Ocean City, MD
National Provider Identifier
1316949787
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0032615 Issued in MD
Legal business name
126TH STREET MEDICAL
Practice address
12601 D Coastal Highway
Ocean City, MD 21842-9784
Phone
(410) 250-8000
Fax
(410) 250-1308
NPI assigned
Aug 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Victor Gong, MDNPI 1871594689
Title
Medical Officer
Phone
(410) 250-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X D0032615 MD Primary

Addresses

Primary practice location

12601 D Coastal Highway
Ocean City, MD 21842-9784

Mailing address

12601 D Coastal Highway
Ocean City, MD 21842-9784
Phone (410) 250-8000

National Provider Directory

National Provider Directory

Locations

12601 Coastal Hwy
Ste D
Ocean City, MD 21842
Phone (410) 250-8000

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1316949787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12601 D COASTAL HIGHWAY",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218429784",
            "telephone_number": "410-250-8000",
            "fax_number": "410-250-1308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12601 D COASTAL HIGHWAY",
            "city": "OCEAN CITY",
            "state": "MD",
            "postal_code": "218429784",
            "telephone_number": "410-250-8000",
            "fax_number": "410-250-1308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "126TH STREET MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GONG",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "MEDICAL OFFICER",
        "authorized_official_telephone_number": "410-250-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0032615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.