Provider Demographics
NPI:1285812503
Name:STANELY CHUNG, M.D.,P.A.
Entity type:Organization
Organization Name:STANELY CHUNG, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-663-0131
Mailing Address - Street 1:187 THOMAS JOHNSON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4445
Mailing Address - Country:US
Mailing Address - Phone:301-663-0131
Mailing Address - Fax:301-698-9449
Practice Address - Street 1:187 THOMAS JOHNSON DR STE 1
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4396
Practice Address - Country:US
Practice Address - Phone:301-663-0131
Practice Address - Fax:301-698-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5522404400Medicaid
MDG26762Medicare UPIN
MD1216120001Medicare NSC
MD5522404400Medicaid