Healthcare Provider Details

I. General information

NPI: 1750672747
Provider Name (Legal Business Name): BUER SONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2011
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 GREAT VALLEY PKWY
MALVERN PA
19355-1309
US

IV. Provider business mailing address

107 GREAT VALLEY PKWY
MALVERN PA
19355-1309
US

V. Phone/Fax

Practice location:
  • Phone: 424-645-2254
  • Fax:
Mailing address:
  • Phone: 424-645-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number284764
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number284764
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA10937500
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD471684
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: