Provider Demographics
NPI:1093000556
Name:SONG, FINE (MD)
Entity Type:Individual
Prefix:DR
First Name:FINE
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 1:1821 HILLANDALE RD STE 24B
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2671
Mailing Address - Country:US
Mailing Address - Phone:919-383-4355
Mailing Address - Fax:919-383-7694
Practice Address - Street 1:1821 HILLANDALE RD STE 24B
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2671
Practice Address - Country:US
Practice Address - Phone:919-383-4355
Practice Address - Fax:919-383-7694
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66753-20207Q00000X
CAA130639207Q00000X
NC2019-01948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1109OtherMEDICARE