Provider Demographics
NPI:1679720221
Name:SONG, YOUNG-SOO (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG-SOO
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YOUNG-SOO
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:LAHEY HOSPITAL AND MEDICAL CENTER
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-8430
Mailing Address - Fax:781-744-5397
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:LAHEY HOSPITAL AND MEDICAL CENTER
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-8430
Practice Address - Fax:781-744-5397
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257013207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology