Provider Demographics
NPI:1972599249
Name:WONSOCK SHIN MD LLC
Entity type:Organization
Organization Name:WONSOCK SHIN MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WONSOCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-759-3800
Mailing Address - Street 1:925 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1845
Mailing Address - Country:US
Mailing Address - Phone:301-759-3800
Mailing Address - Fax:301-777-7455
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1845
Practice Address - Country:US
Practice Address - Phone:301-759-3800
Practice Address - Fax:301-777-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
891935OtherMAMSI ID
MD363200800Medicaid
MDLP49CHOtherBC/BS OF MD
9795404002OtherCIGNA ID
9795404002OtherCIGNA ID