MEDICARE: WONSOCK SHIN MD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D0055325	MD

General Provider Information

NPI Number	:	1073789624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WONSOCK SHIN MD, LLC

Provider Business Mailing Address
First Line	:	925 BISHOP WALSH RD
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1845
Country	:	US
Telephone Number	:	301-759-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 BISHOP WALSH RD
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1845
Country	:	US
Telephone Number	:	301-759-3800
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. WONSOCK SHIN
Credential	:	M.D.
Telephone Number	:	301-759-3800

Provider Enumeration Date	:	05/05/2008
Last Update Date	:	05/05/2008

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