Provider Demographics
NPI:1821069204
Name:CHON, SONG C (MD, FCCP)
Entity Type:Individual
Prefix:MR
First Name:SONG
Middle Name:C
Last Name:CHON
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 REGENCY PL STE 303
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3077
Mailing Address - Country:US
Mailing Address - Phone:301-645-3420
Mailing Address - Fax:301-645-3423
Practice Address - Street 1:4475 REGENCY PL STE 303
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3077
Practice Address - Country:US
Practice Address - Phone:301-645-3420
Practice Address - Fax:301-645-3423
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37174207RP1001X
MDD0037174207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
263154YL6COtherMCR NUMBER
MD060031800Medicaid
MD290014253OtherRAILROAD MEDICARE
MDE39435Medicare UPIN
MD290014253OtherRAILROAD MEDICARE