MEDICARE: DR. EDWARD CHUNG MD

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	207R00000X	Internal Medicine Physician	200100662	NC
2	208M00000X	Hospitalist Physician	200100662	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	1174510804	OTHER	NC	RAILROAD MEDICARE
5	1174510804	OTHER	NC	BLUE MEDICARE
6	110238891	OTHER	NC	RAILROAD MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	132F2	OTHER	NC	BLUECROSS BLUESHIELD

General Provider Information

NPI Number	:	1174510804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD CHUNG MD

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	336-718-7080
Fax Number	:	336-718-9622

Provider Business Practice Location Address
First Line	:	3333 SILAS CREEK PARKWAY
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-3013
Country	:	US
Telephone Number	:	336-718-7080
Fax Number	:	336-718-9622

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	10/25/2020

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Directions to “ DR. EDWARD CHUNG MD” Practice Location

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