Provider Demographics
NPI:1750672747
Name:SONG, BUER (MD)
Entity Type:Individual
Prefix:
First Name:BUER
Middle Name:
Last Name:SONG
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 1:107 GREAT VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1309
Mailing Address - Country:US
Mailing Address - Phone:424-645-2254
Mailing Address - Fax:
Practice Address - Street 1:107 GREAT VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1309
Practice Address - Country:US
Practice Address - Phone:424-645-2254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284764207ZP0102X, 207R00000X
NJ25MA10937500207ZP0102X
PAMD471684207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine