Provider Demographics
NPI:1992038525
Name:SONG, XINDE (PA)
Entity Type:Individual
Prefix:MR
First Name:XINDE
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2 BERNARDINE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 BERNARDINE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5963
Practice Address - Country:US
Practice Address - Phone:757-599-4922
Practice Address - Fax:757-599-4927
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003128146D00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant