Provider Demographics
NPI:1982715256
Name:SONG, MIN (MD)
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:SONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MIN KEUN
Other - Middle Name:
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:199 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186
Mailing Address - Country:US
Mailing Address - Phone:617-696-7600
Mailing Address - Fax:617-696-7604
Practice Address - Street 1:199 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186
Practice Address - Country:US
Practice Address - Phone:617-696-7600
Practice Address - Fax:617-696-7604
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233356207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine