Active NPI
Song Suck Chung, MD
- Gynecology Physician
- Glen Burnie, MD
National Provider Identifier
1700968047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- D14172
- Practice address
- 1412 N Crain Hwy
Suite 6a
Glen Burnie, MD 21061-9306 - Phone
- (410) 582-9292
- Fax
- (410) 582-9295
- NPI assigned
- Oct 19, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | D14172 | MD | Primary |
Addresses
Primary practice location
1412 N Crain Hwy
Suite 6a
Glen Burnie, MD 21061-9306
Mailing address
PO Box 558
Stevenson, MD 21153-0558
Phone (410) 582-9292
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05740001 | Other | MD | BLUE CHOICE |
| KFJ3 | Other | MD | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14172 | MD | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medstar Harbor Hospital Physicians LLC | Past | Accepting new patients | |
| Harbor Hospital | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Baltimore, MD
- NPI 1831110873
-
dba MHHP LLC
- General Practice Physician
- Baltimore, MD
- NPI 1386067783
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1700968047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 558",
"city": "STEVENSON",
"state": "MD",
"postal_code": "211530558",
"telephone_number": "410-582-9292",
"fax_number": "410-582-9295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 N CRAIN HWY",
"address_2": "SUITE 6A",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210619306",
"telephone_number": "410-582-9292",
"fax_number": "410-582-9295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUNG",
"first_name": "SONG",
"middle_name": "SUCK",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "MD",
"license": "D14172",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE",
"identifier": "05740001",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "KFJ3",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.