Provider Demographics
NPI:1184654758
Name:CHUNG, RACHEL H (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:H
Last Name:CHUNG
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 1:38 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-5516
Mailing Address - Country:US
Mailing Address - Phone:203-855-3757
Mailing Address - Fax:203-920-1690
Practice Address - Street 1:38 EAST AVE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5516
Practice Address - Country:US
Practice Address - Phone:203-855-3757
Practice Address - Fax:203-920-1690
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43475207Q00000X
CT61122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN877903100Medicaid
MN877903100Medicaid
MNH36684Medicare UPIN