Provider Demographics
NPI:1588667976
Name:TUNG, CHEN YUAN (MD)
Entity Type:Individual
Prefix:
First Name:CHEN
Middle Name:YUAN
Last Name:TUNG
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 1:310 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4546
Mailing Address - Country:US
Mailing Address - Phone:301-694-5900
Mailing Address - Fax:301-698-9236
Practice Address - Street 1:310 W 9TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4546
Practice Address - Country:US
Practice Address - Phone:301-694-5900
Practice Address - Fax:301-698-9236
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55518207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD135900200Medicaid
MD930ZMedicare ID - Type Unspecified
MD135900200Medicaid