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General NPI Number Information
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NPI Number | 1982782686
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Entity Type | Organization
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Legal Business Name | SOUTHERN MARYLAND PULMONARY & CRITICAL CARE, P.A.
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 3575 OLD WASHINGTON RD SUITE C
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City | WALDORF
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State | MD
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Zip | 20602-3269
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Country | US
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Telephone | 301-645-3420
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Fax | 301-645-3423
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Provider Business Mailing Address
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Address Line | 3575 OLD WASHINGTON RD SUITE C
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City | WALDORF
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State | MD
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Zip | 20602-3269
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Country | US
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Telephone | 301-645-3420
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Fax | 301-645-3423
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | DR. SONG C CHON
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Credential | D12587
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Telephone | 301-645-3420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | D4760773
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License Number State | MD
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