Provider Demographics
NPI:1821977802
Name:SONG, JOYCE (PA-C)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:SONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15001 SHADY GROVE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6353
Mailing Address - Country:US
Mailing Address - Phone:301-340-3252
Mailing Address - Fax:202-823-4805
Practice Address - Street 1:15001 SHADY GROVE RD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6353
Practice Address - Country:US
Practice Address - Phone:301-340-3252
Practice Address - Fax:202-823-4805
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty