Provider Demographics
NPI:1609895200
Name:CHUNG, THEODORE D (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:D
Last Name:CHUNG
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:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7691
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0058
Practice Address - Country:US
Practice Address - Phone:804-828-7232
Practice Address - Fax:804-828-6042
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012278992085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007229933Medicaid
VA007229933Medicaid
VA920000103Medicare ID - Type UnspecifiedC03041