Provider Demographics
NPI:1982661823
Name:CHUNG, CHARLES J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:400 W ROSEMARY ST UNIT 406
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-2345
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-836-4696
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-649-9000
Practice Address - Fax:716-649-9005
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-16511207U00000X, 2085R0202X
NC96008862085R0202X
NY2347012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010234701OtherBLUE CHOICE
050922000000OtherFIDELIS
000528052007OtherBLUE SHIELD WNY
P00232918OtherRR MEDICARE
00027018504OtherUNIVERA
4193544OtherGHI
P00193057OtherRR MEDICARE
00027018501OtherUNIVERA
0142853OtherGHI
196562FFOtherPREFERRED CARE
NY2347011WOtherNYS WORKERS COMPENSATION
P020234701OtherBLUE SHIELD OF ROCHESTER
NY000528052001OtherBLUE SHIELD WNY
NY01756523Medicaid
1612812OtherINDEPENDENT HEALTH
P00232918OtherRR MEDICARE
050922000000OtherFIDELIS
NY2347011WOtherNYS WORKERS COMPENSATION
NYRA5960Medicare ID - Type Unspecified