MEDICARE: NAMSOO 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	2084P0800X	Psychiatry Physician	45048	MA

General Provider Information

NPI Number	:	1144207796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAMSOO SONG M.D.

Provider Business Mailing Address
First Line	:	22 DRAPER RD
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-1610
Country	:	US
Telephone Number	:	508-785-2972
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 DRAPER RD
Second Line	:
City	:	DOVER
State	:	MA
Zip	:	02030-1610
Country	:	US
Telephone Number	:	508-785-2972
Fax Number	:

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

Provider Enumeration Date	:	12/26/2005
Last Update Date	:	07/08/2007

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