Provider Demographics
NPI:1053589499
Name:BANG, STACY JUNG (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:JUNG
Last Name:BANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3204 TOWER OAKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4250
Mailing Address - Country:US
Mailing Address - Phone:301-231-5088
Mailing Address - Fax:301-231-5254
Practice Address - Street 1:3204 TOWER OAKS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4250
Practice Address - Country:US
Practice Address - Phone:301-231-5088
Practice Address - Fax:301-231-5254
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC121016207W00000X
MDD67187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC158913L99Medicare PIN