Provider Demographics
NPI:1073505681
Name:CHUNG, MAURICE K (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:K
Last Name:CHUNG
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 1:310 S CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-3110
Mailing Address - Country:US
Mailing Address - Phone:419-228-1000
Mailing Address - Fax:419-227-3085
Practice Address - Street 1:310 S CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-3110
Practice Address - Country:US
Practice Address - Phone:419-228-1000
Practice Address - Fax:419-227-3085
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000330743I207VF0040X
OH35058390207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0742307Medicaid
OH160019139OtherRR MEDICARE
OHP01387049OtherMEDICARE PTAN
OH29189OtherANTHEM
OH0742307Medicaid
OHP01387049OtherMEDICARE PTAN
OH0653745Medicare PIN
OH0653749Medicare PIN
OH29189OtherANTHEM
OH0653746Medicare PIN