Provider Demographics
NPI:1912050972
Name:TUNG, MINGZER (MD03)
Entity type:Individual
Prefix:DR
First Name:MINGZER
Middle Name:
Last Name:TUNG
Suffix:
Gender:M
Credentials:MD03
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OLD HAWLEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1216
Mailing Address - Country:US
Mailing Address - Phone:203-426-4933
Mailing Address - Fax:
Practice Address - Street 1:49 OLD HAWLEYVILLE RD
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-1216
Practice Address - Country:US
Practice Address - Phone:203-426-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT138337Medicaid
CTF70776Medicare UPIN