Provider Demographics
NPI:1902809684
Name:CHUNG, PHILIP R (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:R
Last Name:CHUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7300 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3079
Mailing Address - Country:US
Mailing Address - Phone:703-753-4733
Mailing Address - Fax:703-753-2183
Practice Address - Street 1:7300 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3079
Practice Address - Country:US
Practice Address - Phone:703-753-4733
Practice Address - Fax:703-753-2183
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL7335207W00000X
VA0101239485207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1675183-01Medicaid
TX8C2452Medicare ID - Type UnspecifiedMEDICARE
TX1675183-01Medicaid
TXI16276Medicare UPIN