Provider Demographics
NPI:1013214535
Name:GUO, SONGCHUAN (MD)
Entity Type:Individual
Prefix:
First Name:SONGCHUAN
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 60TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4209
Mailing Address - Country:US
Mailing Address - Phone:718-439-3250
Mailing Address - Fax:718-492-4575
Practice Address - Street 1:757 60TH ST FL 5
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4209
Practice Address - Country:US
Practice Address - Phone:718-439-3250
Practice Address - Fax:718-492-4575
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272302207RH0003X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04056093Medicaid