Provider Demographics
NPI:1215999230
Name:OUNG, IRENE (MD)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:OUNG
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 1:711 W 40TH ST
Mailing Address - Street 2:ROTUNDA 429/430
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2120
Mailing Address - Country:US
Mailing Address - Phone:410-554-5434
Mailing Address - Fax:410-554-5436
Practice Address - Street 1:711 W 40TH ST
Practice Address - Street 2:ROTUNDA 429/430
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2120
Practice Address - Country:US
Practice Address - Phone:410-554-5434
Practice Address - Fax:410-554-5436
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG06925Medicare UPIN
MD089L533MMedicare ID - Type Unspecified