Provider Demographics
NPI:1043453624
Name:SONG, CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:SONG
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 1:200 EXCHANGE ST
Mailing Address - Street 2:UNIT 814
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-2621
Mailing Address - Country:US
Mailing Address - Phone:518-429-3083
Mailing Address - Fax:
Practice Address - Street 1:950 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1432
Practice Address - Country:US
Practice Address - Phone:401-606-1004
Practice Address - Fax:401-606-1153
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253136207R00000X
RIMD14976207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine