Provider Demographics
NPI:1386660835
Name:NAM, MYUNG HEE (MD)
Entity Type:Individual
Prefix:
First Name:MYUNG
Middle Name:HEE
Last Name:NAM
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:PO BOX 79599
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0599
Mailing Address - Country:US
Mailing Address - Phone:800-655-2656
Mailing Address - Fax:412-822-7411
Practice Address - Street 1:400 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4506
Practice Address - Country:US
Practice Address - Phone:800-655-2656
Practice Address - Fax:412-822-7411
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0035106207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD297991800Medicaid
DC74960002OtherCAREFRIST BCBS
MD53298205OtherCAREFIRST BCBS
015488167Medicare ID - Type UnspecifiedMEDICARE ID#
MD418PQ797Medicare PIN
MDP00418901Medicare PIN
DC74960002OtherCAREFRIST BCBS
MD297991800Medicaid