Provider Demographics
NPI:1265471965
Name:SONG, SANG (MD)
Entity Type:Individual
Prefix:
First Name:SANG
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 1:501 BATH RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3101
Mailing Address - Country:US
Mailing Address - Phone:215-785-9200
Mailing Address - Fax:215-785-9039
Practice Address - Street 1:501 BATH RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3101
Practice Address - Country:US
Practice Address - Phone:215-785-9200
Practice Address - Fax:215-785-9039
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD03172L174400000X, 207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023022000OtherIBC
PA34005BOtherKEYSTONE MERCY
PA000953068 0003Medicaid
PA141292OtherHIGHMARK BLUE SHIELD
PA000953068 0003Medicaid