Provider Demographics
NPI:1639123672
Name:NAMKOONG, SUK (MD)
Entity Type:Individual
Prefix:
First Name:SUK
Middle Name:
Last Name:NAMKOONG
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 1:77 HOSPITAL AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2550
Mailing Address - Country:US
Mailing Address - Phone:413-664-6111
Mailing Address - Fax:413-663-3923
Practice Address - Street 1:77 HOSPITAL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2550
Practice Address - Country:US
Practice Address - Phone:413-664-6111
Practice Address - Fax:413-663-3923
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221288207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2080231Medicaid
MAI14063Medicare UPIN
MAA37450Medicare ID - Type Unspecified