Provider Demographics
NPI:1164411591
Name:SONG, JULIE HYE YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:HYE YOUNG
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2099542085R0202X
RI106422085R0202X
RIMD106422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0161853OtherMASSMEDICAID
3080787OtherCIGNA
000000001988OtherNHPRI
243021OtherRIHPILGRIM
300123642OtherRAILROAD MEDICARE
003117232OtherCT MED ASSISTANCE
7009119OtherRIMEDICAL ASSISTANCE
010642OtherTUFTS
1650203OtherUNITEDHEALTHPLANS
0161853OtherHEALTHYSTART
007009120OtherHOSPITALPIN
408549OtherBLUECHIP
10642OtherBLUESHIELD
3080787OtherCIGNA