Provider Demographics
NPI:1013062850
Name:SHUM, CHUNG HO (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHUNG
Middle Name:HO
Last Name:SHUM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SARATOGA AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4218
Mailing Address - Country:US
Mailing Address - Phone:207-945-5795
Mailing Address - Fax:
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:WEBBER WEST 541
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6641
Practice Address - Country:US
Practice Address - Phone:207-941-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428108207ZP0102X
CAA98612207ZP0102X
ME017501207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology