MEDICARE: LIQUN SONG M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	044563	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699839852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIQUN SONG M.D.

Provider Business Mailing Address
First Line	:	135 DIVISION ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2135
Country	:	US
Telephone Number	:	203-735-3500
Fax Number	:	203-735-0505

Provider Business Practice Location Address
First Line	:	135 DIVISION ST
Second Line	:
City	:	ANSONIA
State	:	CT
Zip	:	06401-2135
Country	:	US
Telephone Number	:	203-735-3500
Fax Number	:	203-735-0505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	12/11/2012

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Directions to “ LIQUN SONG M.D.” Practice Location

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