Provider Demographics
NPI:1073645560
Name:KUANG, QIAO TING (MD)
Entity Type:Individual
Prefix:DR
First Name:QIAO TING
Middle Name:
Last Name:KUANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TING
Other - Middle Name:
Other - Last Name:KUANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1250 HANCOCK ST
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4339
Mailing Address - Country:US
Mailing Address - Phone:617-774-0840
Mailing Address - Fax:617-774-0882
Practice Address - Street 1:1250 HANCOCK ST
Practice Address - Street 2:PRESIDENTS PLACE - SOUTH TOWER
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4339
Practice Address - Country:US
Practice Address - Phone:617-774-0840
Practice Address - Fax:617-774-0882
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP00491207R00000X
MA231947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2150891Medicaid
MA000377001Medicare PIN