MEDICARE: S & SONG INC

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	364S00000X	Clinical Nurse Specialist	R057717	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54664301	OTHER	MD	BCBS

General Provider Information

NPI Number	:	1275558868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	S & SONG INC

Provider Business Mailing Address
First Line	:	4616 MORNING RIDE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	410-461-4425
Fax Number	:	410-462-3517

Provider Business Practice Location Address
First Line	:	4616 MORNING RIDE CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042
Country	:	US
Telephone Number	:	410-829-5148
Fax Number	:	410-462-3517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. SOONOK KONG SONG
Credential	:	CNS-PMM
Telephone Number	:	410-829-5148

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/22/2020

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Directions to “S & SONG INC ” Practice Location

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