Provider Demographics
NPI:1295873396
Name:SONG, SUZAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WISCONSIN CIR STE 700
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-7007
Mailing Address - Country:US
Mailing Address - Phone:202-681-7665
Mailing Address - Fax:
Practice Address - Street 1:2 WISCONSIN CIR STE 700
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-7007
Practice Address - Country:US
Practice Address - Phone:202-681-7665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1045622084P0800X
MA2252902084P0800X
DCMD0445882084P0804X
MDD939702084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry