Provider Demographics
NPI:1285907535
Name:CHUNG, MARCIA ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ANNE
Last Name:CHUNG
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-489-5454
Mailing Address - Fax:956-252-2018
Practice Address - Street 1:10710 MCPHERSON RD STE 305
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6271
Practice Address - Country:US
Practice Address - Phone:956-489-5454
Practice Address - Fax:956-252-2018
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267251208600000X
TXS5344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1A5080OtherMEDICARE
TX409723001Medicaid