Basic Information
| Provider Information | |||||||||
| NPI: | 1164646311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOONG | ||||||||
| FirstName: | MEJAH | ||||||||
| MiddleName: | SHIREEM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 WESTERN AVE | ||||||||
| Address2: | #193 | ||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041061705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075214825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | CATHOLIC MEDICAL CENTER | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036683545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 041648 | CT | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.