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General NPI Number Information
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NPI Number | 1700968047
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Entity Type | Individual
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Provider Name | SONG SUCK CHUNG MD
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1412 N CRAIN HWY SUITE 6A
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City | GLEN BURNIE
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State | MD
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Zip | 21061-9306
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Country | US
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Telephone | 410-582-9292
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Fax | 410-582-9295
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Provider Business Mailing Address
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Address Line | PO BOX 558
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City | STEVENSON
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State | MD
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Zip | 21153-0558
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Country | US
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Telephone | 410-582-9292
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Fax | 410-582-9295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | D14172
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License Number State | MD
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