Provider Demographics
NPI:1972779940
Name:TUNG, CHRISTIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:E
Last Name:TUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTIE
Other - Middle Name:E
Other - Last Name:TUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1768 BUSINESS CENTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5324
Mailing Address - Country:US
Mailing Address - Phone:408-313-9809
Mailing Address - Fax:
Practice Address - Street 1:1768 BUSINESS CENTER DR
Practice Address - Street 2:STE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5324
Practice Address - Country:US
Practice Address - Phone:408-313-9809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1091552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology