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Gary Xin Gong

Radiology

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as GARY GONG.

Based on the most recent information from CMS, provider Gary Xin Gong is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1154373157
Provider Type
Individual
Full Name
Gong, Gary Xin
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/17/2006
Last Updated
9/5/2024

Contact Information

Practice Location

600 N Wolfe St, Baltimore, MD 21287

(410) 955-6500

Unlisted Fax

Mailing Location

6201 Greenleigh Ave, Middle River, MD 21220-2004

(410) 933-6423

(410) 500-4266

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License D61497 Maryland
Code 2085R0202X	Description Radiology Allopathic & Osteopathic Physicians	License 056776 Connecticut

Provider Identifiers

ID	Description	Issuer
ID 4048407000	Description Medicaid	Issuer Unlisted Maryland

Gary Xin Gong

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Haviazheu, Dzmitry

Hafezi Nejad, Nima

Barazanji, Maha H

Tank, Dharmesh

Rangani, Paresh

Scott, William

Kwak, Stephen

Lurito, Joseph T

Gujar, Sachin K

D'Angelo, Michael Wayne