Provider Demographics
NPI:1538100383
Name:RO, SUNG C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:C
Last Name:RO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SUNG
Other - Middle Name:C
Other - Last Name:RO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6751 TANGLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6716
Mailing Address - Country:US
Mailing Address - Phone:901-755-0606
Mailing Address - Fax:
Practice Address - Street 1:3155 JOFFRE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-3430
Practice Address - Country:US
Practice Address - Phone:901-251-8086
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010748173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04417Medicare UPIN